I, the parent/guardian of the child/children named above, by providing my name below hereby give permission for my child/children named above to take part in the e Youth Winter Jam trip.  I understand that the following conditions apply:

a. I understand that I am responsible for getting my child to and from the departure and return site(s).  I understand that my child shall be accompanied by staff member and volunteers during the trip, including while traveling from the departure site to the destination site, and from the destination site to the return site.

b. I understand that my child is expected to behave responsibly.

c. I agree and understand that I am responsible for the actions of my child, and I release Encounter Church, Encounter Church staff, and Encounter Church volunteers from all claims and liabilities that arise in connection with the event.

d. Unless noted otherwise in the field below, I confirm that my child is medically fit and able to participate in all activities for the event(s) selected

e. I have indicated in the field below any permanent or temporary medical or other condition(s) including special dietary and medication needs, or the need for visual or auditory aids, which should be known about my child:  (please write "N/A" if this does not apply to your child)

f. I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child.