MSM Parental Consent Form 2025-26

2025-2026 Academic Year

Only one parental consent form needs to be filled out each school year. If you have already filled it out for this school year, you do not have to fill it out again.

Your name *

Email address *

Student Information

Student's First Name *

Student's Last Name *

Phone Number

Address *

Birthday *

Graduation Year *

Gender *

Are there any medical restrictions or allergies? *

Yes

Is your child covered by medical insurance? *

Yes

Do you have a family doctor? *

Yes

Parent/Guardian Information

Parent/Guardian's First Name *

Parent/Guardian's Last Name *

Parent/Guardian's Email Address *

Phone Number *

Emergency Contact

Please provide two emergency contacts

Name of primary emergency contact *

Phone Number *

Name of secondary emergency contact *

Phone Number *

Liability Release

As parent/guardian of above-referenced individual hereby acknowledge that it is my desire for my child to participate in (any or all) EVENTS FROM 5/2025-5/2026 with TRINITY CHURCH, including all activities on and away from the church premises as well as transportation, which is by bus, private vehicle or public transportation of all forms, of which I approve of and authorize as the mode of transporting my child for the above-referenced event. I hereby authorize the officials in charge of said program to administer what medical measures that they may deem necessary for my child's safety and health.

As lawful consideration for permitting the above-referenced individual to participate in (any or all) EVENTS FROM 5/2025-5/2026, including all activities, all transportation to and from such activities, I hereby release and discharge TRINITY CHURCH, its officers, employees, agents and Board of Elders from all actions, claims or demands I and my heirs, distributees, guardians, legal representatives or assigns now have or may hereafter have for any injury or damages resulting from the negligence or other acts, howsoever caused, by such church, officers, employees, agents and Board of Elders, before or during my child's participation in such church-sponsored activities on and/or away from the church premises, including transportation to and from such activities. I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and an assumption of risks and sign it of my own free will.

This consent and Release from Liability shall remain effective until revoked in writing and delivered to any officer, employee or agent of TRINITY CHURCH.

I understand, that in the event my child behaves in a manner deemed unacceptable by an adult leader, I will pick up or make arrangements for pickup, of my child at my own expense.

Photo and Media Release

I hereby give my permission for TRINITY CHURCH to use photographs and recordings containing my child’s image, likeness, or voice on its official website, social media, printed publications, video recordings, and television or motion picture productions that will be produced, used, or distributed for legitimate purposes and without further consideration.

I have read and agree with the "Liability Release" *

I have read and agree with the "Photo and Media Release"

Parent Signature *

By typing my name below I hereby agree that I have read through each release and that all information is correct.

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