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Event Permission Form
PVD@dm1n_072415
2022-08-24T17:53:31-04:00
Youth Ministry - Permission Slip and Parental Consent/Release Form
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3
33%
Name
First
Last
Age
DOB
MM slash DD slash YYYY
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Home Phone
Cell Phone
Emergency Contact:
First
Last
Emergency Phone
List any allergies the student may have:
Are there any medical concerns?
Date:
MM slash DD slash YYYY
FIELD TRIP DESTINATION:
DEPARTURE TIME:
Hours
:
Minutes
AM
PM
AM/PM
PICK-UP TIME:
Hours
:
Minutes
AM
PM
AM/PM
Consent
(Required)
I agree to consent
I agree and understand that Cathedral International will not purchase a ticket for me or anyone I am approving to attend this event.
Consent
(Required)
I agree to consent
In consideration of my child’s participation in the Youth Ministry, I hereby freely and unconditionally release, waive and forever discharge any and all liability or claims I may have and agree to defend and hold harmless, Cathedral International, Cathedral International Youth Ministry, their employees, other representatives, agents, program participants, affiliates, related entities, respective staff, leaders and volunteers and their successors and assigns from all liability, claims, lawsuits, judgments and decrees or demands for personal injury, sickness or death, as well as property damage and expenses of any nature whatsoever, which may be incurred by my child while he/she is participating in the above described event. I hereby agree to assume sole responsibility for any damages incurred as a result of the negligent, willful or intentional acts of my child and thereby assume any expenses as a result thereof.
I acknowledge and understand that Cathedral International is committed to ensuring that all Youth Ministry activities are conducted in a smoke-, alcohol-, drug-, profanity-, disrespect- and violence-free environment. In light of this and to help ensure the safety of all participants, I further understand that if my child is in possession of drugs, alcohol or tobacco products, engages in any illegal conduct or refuses to follow the directions of Cathedral International Staff or Volunteers, I will be called immediately to pick up my child and he/she will be prohibited from any future off-campus activities offered by Cathedral International’s Youth Ministry. In the case of an emergency, Cathedral will immediately contact the parent/legal guardian first, and if the Cathedral cannot contact the parent/legal guardian, the Emergency Contact listed above shall then be contacted.
If anyone other than me is authorized to remove my child from the care of Cathedral International Youth Ministry Staff and/or Volunteers, their name is listed below. I understand that these individuals may be asked to provide photo identification at any time and that absent sufficient proof of identity, Cathedral International Youth Ministry is not obligated to allow them to remove my child.
Name
First
Last
Phone
Relationship
Date
MM slash DD slash YYYY
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.
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