Sr. High River Cats
Who:
What:
Where:
When:
Cost:
Dinner:
Sr High Students
A Trip to the Game
Meet at Church
April 11th @ 5:00pm
$15
Pizza Tailgate Party
Student’s Name:__________________________
Parent/Emergency
Contact Number:_________________
*Optional items to bring: Lawn Chair or blanket, glove for
foulballs, money for snacks inside the stadium, and a warm jacket
(last year was in the low 50’s).
Parent Signature:_________________
For Info or questions please contact Pastor Jared at 916-2307831 or jared@rmchurch.org
River Cats Game Itinerary
5:00pm Meet at Church
6:15pm Pizza Tailgate Party
7:05pm PLAY BALL!
10:00pm Opening Night Fireworks Show
10:15pm Head Home
11:00pm Student Pick up at the Church
Rancho Murieta Community Church
14670 Cantova Way
Rancho Murieta, CA 95683
(916) 354-0401
(916) 354-0120 (Fax)
Rev. Jared Huntsinger
Medical and Liability Release Form
NAME: ______________________________________________ AGE: _____
ADDRESS: _______________________________________________________
CITY: _____________________
ZIP: ______
PHONE: ______________
IN EMERGENCY, NOTIFY: _________________________________________
RELATIONSHIP TO ABOVE: ________________________________________
PHONE: _____________
DOCTOR: _______________________ CITY: _______________________
PHONE: _____________
HEALTH HISTORY:
Allergies: ___ Insect stings Other Conditions ___Diabetes
___Drugs:____________
___Epilepsy
___Other
___Chronic asthma
___Hay fever
___Frequent colds
___Frequent stomach upsets
___Heart Condition
___Physical handicap
___Other
If you checked any of the above, please give details. (i.e., include normal treatment of allergic
reactions):
Date of last tetanus shot:
This is a two-paged form. Please make sure both pages are filled out.
Name and dosage of any medications that must be taken:
Any swimming restrictions:
Yes
No
Any activity restrictions:
Yes
No
Our church's insurance is only secondary insurance. If you have medical insurance, your
carrier will be billed for medical charges in the case of illness or injury while your son or
daughter is on a church-related activity.
Do you have health insurance?
Yes
No
If "yes," Name: ______________________________________________________
Policy Number: ______________________________________________________
Phone Number: ______________________
Address: ___________________________________________________________
"In the event that I cannot be reached in an emergency during the dates specified on this
form, I hereby give my permission to the physician or dentist selected by the church
leadership to hospitalize, to secure proper treatment, and/or order an injection,
anesthesia, or surgery for my son or daughter as deemed necessary."
LIABILITY RELEASE
Every activity sponsored by this church is carefully planned and adequately supervised
by mature adults. However, even with the best of planning and precaution, unforeseen
events can occur. By signing this form, the parent or guardian agrees to assume and
accept all risks and hazards inherent in church-related social activities. They also agree
not to hold this church or its employees or volunteer assistants liable for damages, losses,
or injuries to the person or property undersigned. The parents or guardians understand
that they are signing for the minor listed on this form and the signature is for both a
medical and liability release.
Parent or guardian's signature: ___________________________________________
Valid from____________________ to ______________________________