GBF Release Form

Name___________________________________________________________________

Age__________________ Date of Birth_______________________________________

Parent/Guardian__________________________________________________________

In case of emergency, the best person to contact is:

Name___________________________________________________________________

Relation________________________________ Phone ___________________________

Medical Ins. Company _____________________________________________________

Group# _______________________________ Policy# ___________________________

Family Physician _____________________________ Phone ______________________

Students Allergies ________________________________________________________

Medications Student is taking ______________________________________________

Sponsoring Organization: Grace Bible Fellowship

We the undersigned parent/guardian of the above named participant grant permission for the participant to participate in any event sponsored by Grace Bible Fellowship. We have been advised of the nature & extent of the activities that may take place and represent to you that the participant is physically & mentally able to participate in those activities. We understand that this activity, as any activity for youth, does present the risk of injury to the participant and we have advised the participant of those possibilities. We represent to you that we & the participant assume the risk of any such injury or death & hold any employees, agents, representatives, & volunteers of Grace Bible Fellowship harmless from any liability resulting from the conduct of the participant in this activity and agree to indemnify Grace Bible Fellowship, it's employees, agents, representatives, and volunteers against any claim or liability. We authorize those representatives to arrange for such medical treatment as they may deem advisable for the health & well-being of the participant understanding that immediate consultation to us will occur.

The participant is covered by Medical Insurance _________ Yes __________No
The participant is able to swim ___________Yes ___________ No
We also authorize transportation by an insurance approved driver of Grace Bible Fellowship.

Parent/Guardian ____________________________________________________
                               Signature                                                          Date

Student Participant Agreement

I, the participant, understand that I am under the authority of those leaders in charge. I also, understand that the use or possession of alcoholic beverages, illegal drugs, tobacco, knives, fireworks, firearms, foul language, and / or abusive or lewd behavior are prohibited, and will result in immediate expulsion, without refund, at the expense of myself or parent/guardian. I understand that this is a Christian event & will have a spiritual emphasis and will be modestly dressed. REACH discipline steps: 1) Warning to student. 2) Conference with student, leader,and youth paster. 3) Conference with parent and youth pastor for expulsion.

I have read & discussed these guidelines with my parent/guardian.

Participant ________________________________________________________
                               Signature                                                          Date