First Covenant Church

The mission of First Covenant Church is to unify, nurture and equip the generations to love God and one another and to carry Christ's message into the world.

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Participant Information
Participant Name *
Participant Name
Participant Mobile Phone
Participant Mobile Phone
Participant Birthday *
Participant Birthday
Participant Address *
Participant Address
Parent Information:
Parent Name *
Parent Name
Parent Mobile Phone *
Parent Mobile Phone

Parental Consent and Medical Release:

     By clicking on the "Submit" button above I, the named parent or legal guardian of the above named student, hereby give my permission for the above student to participate in the activity above sponsored by the First Covenant Church of Portland, OR (FCC) youth department.  This includes transportation, which may be provided in the church van or in an adult volunteer’s private vehicle, food, lodging, and photographs which may be used in church publications.
    In the event of a medical emergency, I hereby authorize staff or volunteers representing FCC to act in the best interests of my child.  Such persons may authorize all necessary medical and/or surgical procedures that they deem vital for the health of the person represented above.  I understand that every effort will be made to contact me or the above physician immediately, and that medical or surgical procedures will be implemented only in the event that I cannot be contacted.  
    I assume all risk of, and liability for, any injury, illness, death, or property damage which may occur during church-related activities.  I hereby release and hold harmless FCC, its agents, volunteers and employees from liability, claims, or expenses related to church-activities.  I am solely responsible for all medical costs.  Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action, or otherwise, I hereby assume all transportation costs.