Parent/Guardian of a Minor Consent and Hold Harmless Form

Name of  Activity: ______________________________________Date:____________

Child’s Name:__________________________________________________________

Date of Birth:_____________________ Age:________________ Sex:_____________

Address:_______________________________________________________________

Phone Number:_____________________ Cell Phone Number:___________________

I, _________________________ (printed name of  parent/guardian) being the parent or

legal guardian of _________________________ (printed name of student) have

been informed of the above activity sponsored by Largo First Church of The Nazarene

and hereby give my consent for my child to participate in this activity.

I understand that all reasonable safety precautions will be taken by the leaders of this

activity, and that the possibility of an unforeseen hazard does exist. I further agree not to

hold Largo First Church of The Nazarene, its leaders, employees, and volunteer staff

liable for damages, losses, diseases, or injuries incurred by my child listed on this form.

Signature of Parent/Guardian: _______________________________________________