MSM Contract & Permission Form

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Please fill out the following document. This release form will be saved for the duration of your student's tenure in the Middle School Ministry (MSM). Certain additional permission forms may be required for events and trips. All information will be kept private.

Student's name: *

First and last name

Parent's name(s): *

First and last name(s):

Home address: *

Phone number: *

Additional phone number:

If you would like to add another number, do so here.

Emergency Contact

Not the parent whose info is listed above.

Name: *

Phone number: *

Relationship to student: *

Medical Info & Insurance

Special medical instructions:

Insured by: *

Policy number: *

VBC & MSM Guidelines

Any person attending an activity sponsored by VBC @ The Crossing & the Middle School Ministry must follow these guidelines:

•No tobacco products •No illegal drugs or drug paraphernalia •No alcoholic beverages (before or during any event) •No iPods or electronic devices (unless stated otherwise) •No pornographic materials •No weapons •No other articles or materials that would be considered dangerous or inappropriate at an event related to the church. *

By clicking "yes", you are indicating that you agree to follow these guidelines and understand that in not following any of these guidelines, your parents will be contacted and I could be sent home from the event at your own expense.

Yes

Signatures

The digital signatures (your typed names) of the MSM students and parents are required below.

Student signature: *

Please type your full name below.

Parent signature: *

I hereby give my child permission to attend VBC @ THE CROSSING Student Ministry Events. I also authorize the person(s) in charge to assist in emergency care in case of an accident. Please type your name below.

Submit

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