Vine Student Ministries 2022-23

Please fill out these form for your child/children to be able to participate on our off site events

Your name *

Email address *

Student Information

Household members

Please add information for each student in your household who will be participating in Vine Student Ministries.

Address *

Parent/Guardian Information

Please include your phone number so that the VSM can reach you if needed.

Phone number

This consent form gives permission to seek whatever medical attention is deemed necessary and releases the Vine Church, its staff, and team members of any liability against personal losses. *

I, the parent/guardian completing this form willingly allow my student(s) to participate in events/programs organized by The Vine Church-Vine Student Ministries. I give permission for Vine Student Ministries team members to transport my student(s) as needed. In the event that my student is injured and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event that treatment is required from a physician and/or hospital personnel designated by The Vine Church, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that I will be ultimately responsible for the cost of any medical care not reimbursed by the health insurance provider.

If there is anything else you would like us to know about your student(s) or family, please include that information here. Thank you!

I authorize The Vine Church to take and use photos/videos of my student(s) for brochures, social media, and the website *

Yes

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