2018 Reds Game Aug 12 Evolve & Encounter
Evolve and Encounter are going to the reds game Sunday, August 12

1. Game Sunday 8/12 Total Cost $15 *Scholarships available.
2. Cut off date 8/10 11am
3. You will receive an email reminder
4. WE NEED PARENT DRIVERS - Parent ticket is free! (otherwise I can only bring the first 14 who sign up)
5. IF YOU SIGN UP I WILL BUY YOU A TICKET (so you will still owe $15 if you don't go!)
6. Meet on Sunday Aug 12 at NOON. at LPC ( Will return after the game - it begins at 1:10 p)

Questions? Email: andrew@lebanonpresbyterian.org

Student First Name *
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Student Last Name *
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Student Grade *
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Student School *
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Student Mobile Phone # *
XXX-XXX-XXXX (if you don't have one type: I don't have one :-)
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Student Email
This cannot be a school Email
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Parent Mobile Phone # *
XXX-XXX-XXXX
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Parent Email *
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Family Address *
### Street St City, State ZIP
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Medications: Name of Medicine, For What & Dosage
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Menu Restrictions
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Activity Limitations
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Recent Illness
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Other Comments &/or Helpful Instructions regarding your student
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Name of Designated Adult Emergency Contact 24hr *
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Phone of Designated Adult Emergency Contact 24hr *
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Relationship of Designated Adult Emergency Contact 24hr *
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EMERGENCY MEDICAL, LIABILITY, AND DISCIPLINARY RELEASE *
I understand that all due precautions will be taken, but in spite of this, accidents can happen and illness develop; therefore I will not hold the leaders or directors of the church liable for any illness or accident resulting from the above named child's participation. In case of surgical or medical emergency, I hereby give permission to the physician sponsored by the leaders or directors to hospitalize secure proper treatment, ordering of injection, anesthesia, for the child named above and cover any costs associated with said treatment. I also agree to pay any expense, including the cost of my child being sent home if disciplinary action is deemed necessary. The parents of those students not at the departure vehicles within a reasonable allowance of the designated time will be notified that they must arrange for their student's transportation home. ...................................................................................................................................................................................
I PARENT OF THE ABOVE STUDENT BY TYPING MY NAME DO SIGN THE ABOVE "EMERGENCY MEDICAL, LIABILITY, AND DISCIPLINARY RELEASE" *
Your answer
Remember
Evolve and Encounter are going to the reds game June 30

1. Game 6/30 Total Cost $15 *Scholarships available.
2. Cut off date 8/10 11am
3. You will receive an email reminder
4. WE NEED PARENT DRIVERS - Parent ticket is free! (otherwise I can only bring the first 14 who sign up)
5. IF YOU SIGN UP I WILL BUY YOU A TICKET (so you will still owe $15 if you don't go!)
6. Meet on Sunday Aug 12 at NOON. at LPC ( Will return after the game - it begins at 1:10 p)

Questions? Email: andrew@lebanonpresbyterian.org

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