Disciple Now 2024 Permission and Release Form

Please complete one form per student

Parent/Guardian Contact Information

Important Note: Parent/Guardian will be used as the emergency contact

Student Medical Information

Important Note: Students are NOT allowed to carry medication with them. All medications (prescription or non-prescription) must be listed and will have to be checked-in along with instructions on how to administer (dosage, frequency, etc.).

Permission and Release Acknowledgement

By signing my name below I give my permission for my child to ride on transportation (bus or private vehicles) provided by The Hills Church. I hereby release The Hills Church, its staff and sponsors, from responsibility and liability for any injury or illness that my child may sustain during all aspects of this activity.

In the event of an emergency, I expect to be contacted as soon as reasonably possible if an emergency medical need arises. I hereby authorize an adult leader of this activity, as agent for me, to consent to any X-ray examination; medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon or dentist (as applicable) licensed to practice under the laws of the state where the services are rendered.

I understand as a participant, my child may be photographed or videotaped, during the normal activities of this event, and these photos or videos may be used by the school and/or church in promotional materials.