When: Friday September 18th
Where: Central Bible Church
Time: We will leave from church at 5:30pm. NO DINNER provided, so eat ahead of time. We will be back at church by 11pm.
Release Form:
I promise to obey the direction of the leaders. I understand and will accept any and all disciplinary decisions by the leadership team that results from my insubordination.
Medical and Liability Release
I/We authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray, anesthetic, medical, surgical or dental diagnosis, treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provision of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.
The undersigned does also hereby give permission for our/my child/children to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by Eden Presbyterian Church of Oregon and its associations.
Student Name: ______________________________
Parent Signature: ______________________________
Phone # ______________________________
Date of Birth: __________________ Grade: ___________________________
담당의사 (Family Physician): ____________________Phone: _______________
긴급연락 번호 (Emergency contact)______________________
Medications/allergies(
Will you allow blood transfusion if physician prescribes? (의사에 지시에 따라 필요하다면 수혈을 허락하시겠습니까?) Yes / No
Release Form:
I promise to obey the direction of the leaders. I understand and will accept any and all disciplinary decisions by the leadership team that results from my insubordination.
Medical and Liability Release
I/We authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray, anesthetic, medical, surgical or dental diagnosis, treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provision of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.
The undersigned does also hereby give permission for our/my child/children to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by Eden Presbyterian Church of Oregon and its associations.
Student Name: ______________________________
Parent Signature: ______________________________
Phone # ______________________________
Date of Birth: __________________ Grade: ___________________________
담당의사 (Family Physician): ____________________Phone: _______________
긴급연락 번호 (Emergency contact)______________________
Medications/allergies(
Will you allow blood transfusion if physician prescribes? (의사에 지시에 따라 필요하다면 수혈을 허락하시겠습니까?) Yes / No
