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Middle School Mission Trip 2024

Middle School Mission Trip 2024

June 24 - June 27

$25.00

Students entering 6th-8th grade are invited to join us as we serve in Louisville by bringing the people there the Good News of Christ! We will be partnering with Amos Luka and Fountain of Life Church, and will be sharing the gospel and doing outreach throughout the week. Students will return to Crestwood each evening and will carpool with chaperones each day.

Cost is $25. Please contact Pastor Steve Self ([email protected]) or Laura Hall ([email protected]) with questions.

Please submit your registration first and then pay your ticket after the webpage has refreshed.

Middle School Mission Trip 2024

Name*
First Last
Address*
Street Address City State Zip
Parent Email*
Student Email
Gender*
Age*
Please enter a number from 10 to 60.
Grade*
BirthDate*
MM slash DD slash YYYY
T-shirt size*
Medical Information
Insurance Carrier*
Policy #*
Physican's Name*
Physican's Phone*
List Allergies
List Chronic Illnesses
List drugs currently being taken
Is child subject to motion sickness?
What is child is able to take (or generic equivalent) for motion sickness?*
What is child permitted to take (or generic equivalent) for fever?*
What is child permitted to take (or generic equivalent) for headache?*
What is child permitted to take (or generic equivalent) for flu symptoms?*
Activity/Trip Information
Name of activity/trip you are registering for.*
Activity's Destination
Date of the activity
Parent's Initial*
PHOTO AND VIDEO PERMISSION
Do you give permission for your child to be photographed or videoed?*
By clicking yes, you grant permission for Crestwood Baptist Church to videotape or photograph your child or young person during the church event or normal activities. You understand these photos may be used as church promotional materials.
Emergency Contact Information
Home Phone*
Work Phone
Moblie Phone
Parent(s) or Legal Guardian(s) Name(s)*
Other person to contact if parent/guardian is not available
Phone
RELEASE, HOLD HARMLESS AND INDEMNITY
Name of Student*

I, the undersigned, as parent or legal court appointed guardian of _____________________, a minor under the age of eighteen (18), (“Minor”), with full authority to act on behalf of Minor, do hereby agree and give my consent to the Minor participating in the Programs and Activities at Crestwood Baptist Church. I, on my own behalf and on behalf of Minor, acknowledge that participating in the Programs and Activities involve certain risks and that injuries, death, or other harm (including damage to Minor’s property) could occur to Minor (“Injuries”). By allowing Minor to participate in the Programs and Activities, I, on my own behalf and on behalf of Minor, hereby assume full responsibility for the risk of Injuries, whether caused by negligence or otherwise. I, on my own behalf and on behalf of Minor, and our heirs, successors, assigns, executors and administrators, hereby RELEASE AND HOLD HARMLESS AND AGREE TO INDEMNIFY Crestwood Baptist Church of Crestwood, Kentucky, Inc. and its staff, volunteer leaders, members, employees, deacons, council members, Ministry and Church Leadership (hereinafter collectively referred to as “CBC”) from and against any and all liability, claims, damages, causes of action, loss, costs and expenses (including, without limitation, attorneys fees) for Injuries arising out of or connected with the Programs and Activities, including traveling to and from the Programs and Activities.
MEDICAL CONSENT AND AUTHORIZATION
If, while participating in the Programs and Activities, Minor requires emergency medical treatment, I hereby give my consent for any emergency medical care to be rendered to Minor as may be deemed necessary by any duly licensed physician or dentist. I hereby give my permission to CBC to obtain the emergency medical treatment at any hospital, clinic or other health care provider as may be deemed appropriate. In these circumstances, I hereby request and authorize any duly licensed physicians, dentists and staff, or other licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of Minor, including but not limited to medical transport, hospital tests, injections, anesthesia, surgery and administration of prescription drugs. I assume full responsibility for all medical expenses incurred as a result of such emergency treatment.
Do you grant the above medical consent and authorization?*
By clicking "submit" below, you certify that you are a parent or legal guardian of the above mentioned student and have read and understood this document in its entirety.

Details

Start:: June 24
End:: June 27
Cost:: $25.00
Event Category:: Student Ministry