Forward Registration and Parent Consent Form

Student Name

Parent Name

This address will receive a confirmation email

Phone

Address

Activity Consent

I, the parent/legal guardian of the student referenced above am informed of the Forward Conference Trip occurring on June 25-27, 2026 sponsored by the Student Ministry of Believers Church of Statesboro, Inc. (hereinafter “church”). I certify that I am in receipt of the Event Information Form outlining activities and cost for this event I hereby consent for my child to attend and participate in this event.

Parent Initials

Medical, Dental, or Hospital Care Consent

I consent to any x-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice This authority also extends to any x-ray examination, anesthetic, dental, or surgical diagnosis or treatment and hospital care by a dentist licensed under the Dental Practice Act for my child. I further agree to pay all charges for the dental, medical, As parent or legal guardian of my child, I am responsible for the health care decisions of my child and am authorized to consent to the services to be rendered. I represent that my consent to and agreement to pay for the dental, medical, or hospital care

Parent Initials

Liability Release

I agree that Believers Church shall not be liable to the Responsible Party, or any other person(s), for an injury incurred by my student while participating in this event, unless the injury is specifically covered by the church’s liability policy. I further agree that Believers Church shall not be liable for any damages to my student’s personal property.

Parent Initials

List any allergies/conditions/special needs chaperones should be aware of:

List at least two (2) emergency contacts:

The full $220 amount is due by June 21st. Please see Pastor Chris Hagan with any questions.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit. All Check boxes must be checked for full consent to be given.

Forward Registration and Parent Consent Form

Description

Please Fix the Following