Student Name *
Student Name
Date of Birth *
Date of Birth
Address *
Student Phone *
Student Phone
The undersigned does hereby give permission for (my) child, to attend and participate in The Work Crew sponsored by The Edge *
These dates include arriving early for orientation and planning. In consideration for being accepted for participation in this event we (I), being 21 years of age or older, do hereby release, forever discharge and agree to hold harmless The Edge and the directors thereof from any and all liability, claims, or demands for personal injury, sickness, or death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above-described trip or activity. Furthermore, we (I) [and on behalf of our (my) child-participant of under the age of 21 years] hereby assume risk of personal injury, sickness, death, damage, and expenses as a result of participation in recreation and work activities involved therein. Further, authorization and permission is hereby given to said organization to furnish any necessary transportation, food, and lodging for this participant. The undersigned further hereby agrees to hold harmless and indemnify said organization, its directors, employees, and agents for any liability sustained by said organization as the result of negligent, willful, or intentional acts of said participant, including expenses incurred attendant thereto. We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including, but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action, or otherwise, we (I) hereby assume all transportation costs.
Hospital Insurance *
Physician Phone *
Physician Phone
Mother's Phone
Mother's Phone
Father's Phone
Father's Phone
Pastor's Phone
Pastor's Phone
Confirmation *