Registration



Permission Slip & Medical Waiver

INSTRUCTIONS: If you are under 18 years of age, your parent or guardian must complete this section. If you are 18 years of age or older, you can complete this form for yourself.

Permission Slip for Any Church Related Function and Consent for Medical Treatment for Minors

The undersigned hereby gives permission for the above student to attend the HSM Winter Camp event with Bethany Bible Church. In the event there is an emergency involving my child, permission is hereby granted for Bethany Bible Church personnel to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care to be rendered to the minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice in any state, and to consent to any x-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to the minor by any dentist licensed to practice in any state, and church personnel shall not be held personally liable.

(Typing my name in the space below serves as my digital signature.)

Please provide the following information:


Registration Payment Total

$240.00

Billing Information

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