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Desperation Students Waiver 2022
Permission/Medical Release for:
Address Line 2
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Date Of Birth
I give permission for my child to join the Student Ministry of Desperation Church in any of the activities or trips sponsored by the church, its staff and sponsors. I hereby release them from responsibility and liability for any illness or injury that my child may sustain during this activity. In the event of an emergency, 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, dentist (as appropriate), licensed to practice under the laws of the state where services are rendered, either at a doctor’s office or in any hospital. I expect to be contacted as soon as possible.
This document will be valid and in full effect from January 1, 2021 – December 31, 2022
Emergency Phone 1
Emergency Phone 2
Medications being taken
Medical Insurance Co
Name of policy holder
You will not be allowed to go on any Student trip off-campus with Desperation Church without a permission slip signed by your parent/guardian on file.
If a discipline problem is deemed serious enough, the child will be sent home at the parent’s expense.
I have read and agree to follow these guidelines.
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