Student Ministry Event Permission Form

Student First Name

Student Last Name

Birthdate

Grade

Parent/Guardian First Name

Parent/Guardian Last Name

Email

Phone Number

Allergies

I give permission for my student to attend this event.

Yes

I attended the Parent Meeting on 9/21/2025 and completed the Student Insurance and Emergency Information Form.

Emergency Contacts

Emergency Contact First Name

Emergency Contact Last Name

Phone Number

Secondary Emergency Contact First Name

Secondary Emergency Contact Last Name

Phone Number

Insurance Information

Policy Holder's Name

Relationship to Student:

Insurance Company:

Group/Policy Number:

ID Number:

I/We release Epic Church and its representatives from and in connection with any claim brought by anyone arising out of the above event. I/We further give our permission for any medical treatment deemed necessary while our/my child is under the care of Epic and its representatives as a participant. I/We understand that students who are non-compliant with the rules may be sent home at the parents' expense and responsibility. I/We further give my permission for my child to have his/her picture taken. PARENT(S) OR GUARDIAN(S) MUST COMPLETE THE FOLLOWING FOR EACH CHILD. This form only covers the above named Student Ministry Event. If there are questions or concerns regarding a specific event, parents/guardians can contact us at [email protected]

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Student Ministry Event Permission Form

Emergency Contacts

Insurance Information

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