Parental Consent Form - Zoe

ADVERTISEMENT

Please return forms to
Phone: 919-779-7272
ZOE c/o Elena Ballam
Email:
700 Waterfield Ridge Place
Garner, NC 27529
Parental Consent Form
(Signatures from both parents are required. If one parent is deceased, please attach a death certificate.)
We, _____________________________________________________________(parents/guardians),
give our child __________________________________________________ (name of youth), a minor
of_______________________________________________(address) permission to accompany a ZOE
Ministry team to ____________________________________ (location) and participate as a member of
the group. We acknowledge that we are allowing our child to participate entirely upon our own initiative,
risk, and responsibility.
We further expressly authorize and consent to any x-ray examination, anesthetic, medical or surgical
diagnosis or treatment, and/or hospital care under the general or specific supervision, and on the advice
of, a licensed physician, surgeon, anesthesiologist, dentist, or other qualified medical personnel acting
under their supervision, for our child, should the same become necessary because of illness or injury.
Now, therefore, in consideration of the permission extended to our child to accompany the mission team
and participate in the mission trip, we do hereby for ourselves, our child, our heirs, executors and
administrators, remise, release, and forever discharge the team
leader(s)______________________________ (name/s), ZOE Ministry, as well as all other participants
and sponsors of said mission trip, acting officially or otherwise, from all claims, demands, actions, or
causes of action of any kind including the death of our child or any injury to our child or loss or damage to
property which may occur from any cause during the trip as well as all ground and flight travel incident to
such trip.
It is our intention by this document to consent to our child’s participation in the mission trip, to consent to
allow ___________________________________________ (name of adult on trip) to act in loco parentis
for the duration of the mission trip, and to waive and forego all right of action of ourselves and our child
against the parties herein before named.
Executed in the presence of:
________________________________________________
_______________________________________________
Parent/Guardian Signature
Notary Public
________________________________________________
________________________________________________
Address
________________________________________________
Parent/Guardian Signature
(seal)
________________________________________________
State of________________________________________
________________________________________________
Address
Country of______________________________________

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go