I do hereby give my consent for my child to participate in overnight activities/outings/or events in San Antonio and the state of Texas.  I understand that this form gives my full permission for one (1) year beginning with the date I enter in the form below. 

I have instructed my child on his/her conduct and responsibilities.  I understand that if my child fails to comply with the rules established by the activity leaders, I will be notified and may possibly be required to provide return transportation of my child earlier than the expected return from the activity/event/outing. 

I hereby release Resurrection Baptist church, its leaders, and organizers from all liability from personal injury to my child, as a participant and/or spectator.  In the event all reasonable attempts to contact me have been unsuccessful, I give consent for immediate medical treatment as required, in the judgment of health professionals, while my child attends youth ministry sponsored activities. 

I further understand that this form must be signed and returned to the RBC Activity Leader/Organizer before my child may participate in any recreational activities.

Date*   YOUTH'S NAME First Name* Middle* Last Name* Date of Birth*         PARENT/GUARDIAN PHONE NUMBERS:(SPECIFY CONTACT PRIORITY) Work Home Mobile Priority 1 2 3 N/A Priority 1 2 3 N/A Priority 1 2 3 N/A Parent Email Address*         FAMILY PHYSICIAN Name*         Address*         City* State* Zip* Phone Number*     MEDICAL INSURANCE COMPANY Name Policy Number Name Insured The following information is needed by any hospital or practitioner not having access to a medical history: Allergies* Medication being taken:* Physical Impairments:* Other pertinent facts to which physicians should be alerted:* Date of last tetanus shot* If parent/guardian cannot be reached in case of emergency, call 1st Choice* Name Phone Number   2nd Choice* Name Phone Number   Do you give permission for your child to receive Tylenol or Mortin as determined necessary?* Yes No By submitting this form, you are giving your consent for your child to participate in overnight activities/outings/or events in San Antonio and the state of Texas.* Yes No