Great America trip 2016

Print Application
Reset Application
Great America trip 2016
Who:
When:
Time:
Location:
Costs:
Juniors (9 to 14 yrs)
April 9, 2016
10:00 am to 8:00 pm
Great America in Santa Clara
Entrance to Park: Get season pass or day pass at
your expense
(We recommend you get the season pass as we will go back at least two more times this year)
Inside Park: Bring spending money for food or snacks
Rules while at Great America Theme Park:
We are a Christian Group, so we expect every Junior to dress and behave appropriately knowing that they are
representing Christ and his Church.
• Dress moderately – You may bring shorts to get in the pool or wet rides. Do not bring :
o Shorts that are too short or tight,
o Bikinis
o Tank Tops or
o ANY wardrobe that will reveal too much about your body
• Bring your best behavior. The following will not be allowed:
o Weapons, fireworks or anything illegal
o Fighting
o Teasing
o Bullying
o Disrespecting others (leaders, peers and other park visitors)
o Disobeying the leaders
o Separating from the group
• Bring your best attitude. Do the following
o Have fun
o Respect leaders, peers and other park visitors
Eternal Life Church Great America Permission Slip
My son/daughter
, has my permission to go to Great America Theme Park
with Eternal Life Church’s TeenExtreme Junior’s Department on Saturday April 9, 2016. I will drop him/her
off by 10 am and pick him/her up by 8 pm. My Son/Daughter has read and agrees to the rules and regulations
above. I acknowledge that there are risks associated in this recreational activity where my child might
be exposed to injury and hereby agree to release Eternal Life Church its officers, employees, agents
and volunteers from all liability arising from any harm or injury incurred by the participation of my
child in the program stated above.
Parent / Guardian’s
Signature
Date
Junior’sSignature , have read and understood the rules and regulations set in place for this activity. I
I
will obey the rules as I understand that this activity is a privilege and not an obligation.
Medical Authorization
It is with my full knowledge and permission that my son/daughter _______________________,
participates in church sponsored activities of Eternal Life Church at 965 O’Brien Dr. Menlo Park, CA
94025 on Saturday April 9, 2016. I hereby authorize the Junior group leadership (as designated and
empowered by Eternal Life Church) to consent, on my behalf to such examination of my child by a
licensed physician as is necessary to determine the nature and extent of injuries or illness, including but
not limited to the taking of x-rays and body fluids, and he/she is further authorized to consent to such
treatment as such physician determines to be reasonably necessary under the circumstances except for
those treatments, if any, listed below. I further authorize said person(s) to sign any consent forms
required by any hospital as a condition to the examination or treatment by a physician and /or duly
recognized member of a hospital staff.
I understand that in case of an emergency, my child might be taken to the closest or first available
medical facility which may or may not be covered by my medical insurance carrier and further
acknowledge that I am fully responsible for any costs associated with any illness or injury to my child
during this activity and that treatment may begin prior to my awareness of the situation, but I expect to
be notified at the earliest time that is reasonable possible under the circumstances.
This authorization expires when I pick up my child from the Junior’s Group or 8pm on April 9, 2016.
Exceptions:
___________________________________________________________________
___________________________________________________________________
Medical Insurance Company
Company Name
Address
City State ZIP
Medical Record
#
Parent/Guardian Signature
Contact Information:
Call
Text
Msg
Main Phone
q
q
q
Alternate Phone
Emergency Contact
Emergency Contact Name
Relationship to Child
q
q
q
q
q
q
Date