PRSM Modern Mission Trip
The student ministry is going Ice Skating in Bentonville, AR.
When: January 18
Depart: from PRFBC @ 9:30 am
Return: to PRFBC around 1:30 pm.
Cost: $8 (extra $$ for lunch)
Activities: Ice Skating
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Participant Name *
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Emergency Contact (EC) *
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EC Relation to Participant *
EC Phone Number *
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Participant Allergies, Medical Conditions, Etc.?
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Is sponsor authorized to approve medical treatment? *
Is sponsor authorized to administer over-the-counter pain relievers? *
Medical Insurance Co. Name
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Policy/Group Number
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By checking "I agree" below, the participant (or parent / guardian, if participant is a minor) acknowledges and accepts the risks of physical injury associated with the participation in the activity described above. Except for gross negligence on the part of the sponsor, the participant, or parent / guardian, promises to hold harmless the sponsoring organization and its representatives for any injury related to the activity. The sponsoring organization is authorized to get medical treatment for the participant if need arises. If a dispute over this agreement of any claim for damages arises, the participant, and parent / guardian agree to resolve the matter through a mutually acceptable arbitration process. I hereby give permission for images of my child, captured during this event through both video and photo, to be used solely for the purposes of the church’s promotional material and publications, and waive any rights of compensation or ownership thereto. *
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