EmailMeForm
YOUTH GROUP SKIING & SNOWBOARDING PERMISSION FORM
Friday, February 11, 2022, 3:45-9:30 p.m.
Massanutten Resort
Cost: $49 lift ticket, $45 equipment rental (buy your own ticket online through Massanutten beginning February 1)
Sign-up deadline is Monday, February 7.
Please select ALL that apply:
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I will be at church at 3:45pm for ride.
I will be bringing my own equipment.
I will meet John at Massanutten ticket window at 4:30pm and ride back to the church with the group.
I will meet John at ticket window at 4:30 and have my own ride BOTH WAYS.
Name(s)
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Address
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Phone
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Email
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Health Insurance Provider
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Policy #:
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Any allergies and/or medical needs?
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Emergency Contact:
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Phone # of Emergency Contact:
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PLEASE READ, SIGN & DATE
I/We understand that there are inherent risks involved in any ministry or athletic events; and I/we hereby release the church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child(ren)’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that I/we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the child(ren) named above. I/We also agree to bring my/our child(ren) home at my/our own expense should he/she become ill or if deemed necessary by the youth ministries staff member. This consent form gives permission to seek whatever medical attention is deemed necessary, and releases Covenant Presbyterian Church and its staff of any liability against personal losses of named child(ren). I/We, the undersigned, have legal custody of the child(ren) named above, a minor(s), and have given my/our consent for him/her to attend Skiing and Snowboarding at Massanutten Resort on Friday, February 11, 2022.
Parent/Guardian Signature
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Clear
Parent/Guardian Signature
Clear
Date
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