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Family Information

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Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

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Student Information

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Birth Date

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Food Allergies

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Medical Concerns

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In consideration for New Life Fellowship of Graham providing this described activity for participant named above, we do hereby release and hold harmless New Life Fellowship of Graham and its members as respects this activity, from any loss and liability as a result of injury to and/or damage to property arising out of the actions of or to the participant named in this registration. In case of emergency, we understand every effort will be made to contact the parents or guardians of the participant. In the event that we cannot be reached, we hereby give permission to the physician selected to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for the participant named above. Medical Release Form

Photography Release I grant to New Life Fellowship of Graham, its representatives, and employees the right to take photographs of my child in connection with above- identified activity. I authorize New Life Fellowship of Graham to use and publish the same in print and/or electronically.

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