Student Permission Form | Trinity Church

Student(s) Information

Last Name

First Name

Date of Birth

Age

Sex

Grade (2022-23)

Special Learning/Physical Needs/Disabilities

Allergies: Food/Medicine

Medications currently taking (include dosage)

If to be given at church must be brought in original container.

Parent / Guardian Information

Parent/Guardian’s Name*

Home Phone*

Mom’s Cell Phone

Dad’s Cell Phone

Mom's Cell Phone Carrier

Dad's Cell Phone Carrier

Mom's Email

Dad's Email

Emergency Information

Notify in case of emergency*

Other than parent

Emergency contact phone number*

Medical Insurance Carrier*

Policy Number*

Family Doctor

Office Number*

Permissions

Trinity Church reserves the right to use photos/videos from events on social media or in publications. If you prefer we don't use photos of your child, please contact Erin at etornell@trinitychurchmn.com.

I grant permission for my son/daughter to receive transportation to and from Trinity Church for scheduled outings and events. I authorize the church to provide transportation and hold Trinity Church harmless from any liability due to mishaps occurring during scheduled outings and events.*

I give my permission to any church staff or sponsor to administer first aid or to obtain the services of a licensed physician when emergency medical treatment is required. I understand that I will be notified as soon as possible, concerning any such emergency.*

Parent / Guardian's Signature*

Date*

Comments

This field is for validation purposes and should be left unchanged.