*Insurance information is only needed for grades 5-12
By typing my name below, I am signing this consent form. In doing so I hereby certify that the above information is correct and I grant my permission for the release of medical records in the case of accident during an activity. In case of medical emergency, I understand that every effort will be made to contact the child's parent/guardian. In the event I cannot be reached, I hereby grant permission for the adult leaders of Vriesland Reformed Church to obtain emergency medical care and proper treatment for my child named above, at my expense. Parent/Guardian agrees on behalf of both parents/guardians and the child, to indemnify, defend, and hold harmless the ministry, and its agents, employees, volunteers, and other representatives for injury arising while my child is in their care. I also give permission for the use of photographs and videos including my child to be used in church publicity.