Nineveh Presbyterian Church

Release form for Church Sponsored Activities

I hereby give consent for my child ________________________ to participate in all Nineveh Presbyterian Church Sunday School, Youth programs and activities. 

I am also giving permission for my child to be transported to and from activities and events as a participant in activities sponsored by the Nineveh Presbyterian Church.  I agree to hold harmless Nineveh Presbyterian Church in the event of any accident.

I give NPC permission to authorize medical care if I cannot be reached or the second person named below cannot be reached.

Important Information:

My child is allergic to:  ______________________________________________

My child is currently taking the following medications: _________________________________________________________________

_________________________________________________________________

Swimming ability:  _____________________

In the event of an emergency, I can be reached at:

Home: ____________________

Cell:   _____________________

Name of Medical Insurance Carrier:  _______________________________

Policy Number:   _____________________

If I can not be reached, please contact the following in case of an emergency:

            Name:  ___________________

            Relationship:  ________________

            Home #:  ___________________

            Cell #:  _____________________

_______________________________                                  ________________

Parent or Guardian’s Signature                                               Date

Nineveh Presbyterian Church

Route 7, Nineveh, New York 13813