Out To Serve Friday October 10th | Delburne Gospel Church

Delburne Gospel Church WAIVER & MEDICAL RELEASE FORM

Field Trips and Special Events

Activity: Out To Serve Project at 38102 Range Road 234 on October 10, 2025

We will meet at the church at 10:00 a.m. and return by 2:00 p.m. Lunch will be provided. Please come prepared for the weather and bring water. Youth participants are required to wear closed-toe shoes, full-length pants, and a T-shirt (no tank tops).

Parent Giving Permission Name (Required)

Who is giving permission for this youth to join us on Friday Oct 10th.

Youth Name (Required)

Which youth will be participating and for whom you are granting permission?

Contact Phone Number: (Required)

Parent who is giving permission contact phone number

Email Address (Required)

Parent giving permission email address

Date of Birth for youth participating (Required)

Does your child have any severe allergies? (bee stings, food, penicillin, other drugs)

If yes, please explain:

Is your child bringing any medication with him/her? (Antibiotics, Ventilator, Ritalin) (Required)

If yes, please explain:

Does your child have any physical, emotional, mental, behavioral concerns or limitations that our staff should be aware of? If yes, please explain. (Required)

Precautions are in place for your child's safety, but Delburne Gospel Church, its staff, and volunteers are not liable for accidents or illness. If your child needs special medication, x-rays, or treatment, parents/guardians will be notified immediately.

Are you giving permission for the above child to participate and be transported by DGC? (Required)

By typing YES, you the parent/guardian are giving permission for the named child above to participate and be transported for this youth activity on behalf of Delburne Gospel Church by the individuals deemed eligible by Delburne Gospel Church..

Todays Date

Please choose the date you are giving permission on.

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Delburne Gospel Church

2034 27th Ave
Delburne AB

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