Parkway Ministries - Winter Ramp '25 Forms

Parental Consent Form for Parkway Ministries Sponsored Events

Parkway Ministries
510 East Cumberland Gap Parkway
Corbin, KY 40701
606-528-8100

Activity: Winter Ramp In Cleveland TN
Location of Activity: Omega Center, Cleveland TN
Activity Will Include: Travel to and from services and hotel
Date of Activity: Monday December 29th - January 1st

Child's Name:

Age

Parent's Name

Emergency Phone Number

Special Information

My Child: (Check Applicable Boxes)

has no existing medical conditions that would endanger him/her from participating

has a medical condition that is being treated and poses no danger to his/her participation

is taking prescribed medication(s)

Other:

By signing below, the parent/guardian gives consent to the said child to participate in a church sponsored activity. The undersigned agrees to hold harmless (which means to not assign blame or legal responsibility) Parkway Ministries, its officials and those workers assisting in the activity from any and all harm that may be sustained as a result of or during the activity, including transportation to and from the activity. Parent/Guardian further agrees to resolve any dispute arising from any harm where the matter is, by mutual consent, deemed not covered by this consent or over the consent itself, by submission to binding arbitration.

Date Input

Signature

Contact Info: If you should have any questions, please feel free to send me a text, give me a call, or shoot me a Facebook message. Below is my contact info:

Sandy Bronnert
Phone - 859-351-9775

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Medical Release Form

Parkway Ministries
510 East Cumberland Gap Parkway
Corbin, KY 40701
606-528-8100

Child's Name

Child's Age

Parent's Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Address of Child if different from Above

Apartment, suite, etc.

City

State

Zip/Postal Code

Home Phone Number

Cell Phone Number

Alternative Contact Person:

Relationship:

Phone Number

I hereby authorize the emergency medical treatment of my child while under the care and custody of Parkway Ministries and hold harmless the church and its agents or assigns and representatives, including volunteer workers for any harm deemed to arise from the said treatment or the lack of said treatment. I understand that Parkway Ministries nor its workers are responsible for administering any medications required to be taken by my child and this is the sole responsibility of my child; and I acknowledge that Parkway Ministries nor any of its workers are authorized to make any medical diagnosis nor administer any medical procedures, excepting those actions deemed proper and necessary in an emergency where they may act as a "Good Samaritan" and render aid and assistance as allowed under the laws of Kentucky, whose jurisdiction is agreed to by myself as applicable. A copy of this document shall be valid as though it were an original.

Date:

Signature

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Parental Consent Form for Parkway Ministries Sponsored Events

Medical Release Form

office hours

service times

contact and follow