Student Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

Student's Birthday *

mm/dd/yyyy

MM

DD

YYYY

Asbury/Parent Covenant *

Permission and Medical Release: I, the parent or guardian, grant my permission for my child to participate fully in all Asbury Confirmation program activities, events and trips sponsored by Asbury United Methodist Church. In the event treatment is called for in which a physician (or hospital personnel) is needed, I authorize adult leaders, volunteers or paid, to give such consent for all necessary medical treatment if I cannot be reached or if because of an emergency. Should medical help be needed, I agree to pay either directly and/or through my own health insurance policy all medical or hospital costs and to be solely responsible for said treatment and the cost thereof. I will keep my contact information up to date so I may be contacted as needed. Waiver of Liability: I, the parent or guardian, in consideration of my child being allowed to participate in all Asbury Confirmation events and trips, being the undersigned, intending to be legally bound, hereby waive and release all rights and claims for damages, for injury, accident or liability of any kind which I might have against Asbury United Methodist Church, church staff, volunteer leaders and other participants. I acknowledge that my child will participate at his/her own risk. As a parent or guardian of a participant, I agree to assume full financial responsibility for any damages which my child might inflict and for transportation if my child must be sent home early for any reason. I agree that my child will adhere to rules and conduct on activities by showing respect for people and property. No violence, alcohol, drugs, weapons, or tobacco/vaping products are permitted. Modest and appropriate clothing must be worn. My child will bring expensive items to Asbury Confirmation events and trips at his/her own risk. I understand that failure to comply with these expectations could result in my child being unable to participate in these activities

Yes I agree

Photo/Video Release *

Asbury Church occasionally takes group photos or videos at Confirmation programs and events. If you do not want your child's photo or video to potentially be placed on the website, in publications, or on social media, please indicate by checking no. When photos or videos are used, they will not identify students by name.

Yes, I'll allow my child to be used in pictures & videos

No, please do not use my child in pictures and videos.