If you're old enough to register yourself, put in an emergency contact in here.

I ask for address because it's part of the medical waiver.

By digitally signing this permission form, I hereby grant my permission for the child mentioned above to attend the activity mentioned above.

I also understand the following:

• This event is for youth from age 12 to grade 12 only
• Parents must provide a phone number where they can be reached in case of emergency
• Parents may be called to pick up a child if the child acts in a manner deemed unacceptable by Wilson Younge, youth pastor at Horizon Indy, and/or adult chaperones
• Parents will not receive a refund of fee for early pick-ups due to unacceptable behavior

I hereby waive all claims which I might have against Horizon Christian Fellowship, their agents, and employees for injury, accident, illness or death occurring during or by any reason of the above described activity. I/We, Parents/Guardians of the above named child do hereby authorize HCF as agents for the undersigned to consent, in such case as a parent or guardian cannot be reached by crucial time, to any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by and is given in advance of any specific diagnosis or treatment, and hospital care being required, but is given in advance to provide authority and power on part of the afore stated agents to give a specific consent to any and all such diagnosis, treatment or hospital care which the afore said physician in the exercise of his/her best judgment may deem advisable. This authorization is given pursuant to the provisions of the Civil Code of Indiana.

By typing your name and submitting this form, you agree that this digital signature may be considered your legal signature.