Parent Consent and Medical/Liability Release Form
Student Name(s):
_________________________________
Grade: ______
Address: _______________________________________
_______________________________________
Date of Birth: _______________________
Phone: (
Emergency: (
) ______________________
) __________________
Please record any allergies or current health conditions requiring medical treatment, medications, or special restrictions.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
I hereby give permission for my above child(ren) to join the Ed. Dept Youth Ministry of Good Shepherd Presbyterian
Church (hearby GSPC; located on 1816 S. Desire Ave., Rowland Hts., CA 91748) to go and attend Walk thru the
Bible- Old Testament Seminar at Oceanside Christian Fellowship Church 343 Coral Cir. El Segundo, CA 90245

I (as a parent and/or legal guardian of the above student) also release GSPC, its staff and sponsors, from responsibility and liability from any injury or illness
that my child(ren) may sustain during this activity.

In the case of an accident or emergency, I hereby appoint an adult leader of this activity to act in my/our behalf in authorizing any X-ray examination,
anesthetic, medical, dental, surgical diagnosis and/or treatment to be rendered to the minor under the general or special supervision and on the advice of
any physician or dentist licensed under the laws of the state and/or country where the services are rendered, either at a doctor's office or in any hospital.

The undersigned does also hereby give permission for my/our child(ren) to ride in any vehicle designated by the adult in whose care the minor has been
entrusted while attending and participating in activities sponsored by GSPC EM JR. High Group.
Check all that apply…

YES! I would love to send my child to Church to attend the Walk thru the Bible- Old Testament Seminar at Oceanside Christian

Fellowship Church
Cost: jr high $20 / adults $30 (Seminar, Matierals, & Lunch)
______________________________________________
Parent or Guardian Signature
* * * * RETURN TOP PORTION * * * *
_________________________
Date
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* * * CUT THIS PAPER and Keep This Bottom Portion as a Reminder * * * *

Event: EM Jr. High. Meet at church for Walk thru the Bible- Old Testament Seminar at Oceanside
Christian Fellowship Church. 343 Coral Cir. El Segundo, CA 90245
Drop Off Time:
Saturday, January 9, 2010, 7:30 AM sharp, we will leave.
** If you are late, directions to the event are on the back.
Pick Up Time:
children will call before we leave to church but we should arrive about 5 pm @ Church
Contact Person: Pastor Clark (714-328-2866)
Bring: Something to write with. Warm clothes.
Optional: eat breakfast before you come.
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Oceanside Christian Fellowship: Where Friends Become Family
Cir. El Segundo, CA 90245
Leave GSPC at 7:30 AM. Saturday, January 9, 2010 Registration 8:30
Join us for a Walk Thru the Bible: O.T. Seminar on January 9, 2010. The "Year of the Bible" program has something for everyone. This
fun, action-packed seminar will introduce you to the key characters, places, events, and themes of the Old Testament. You must preregister for this event and space is limited. To register or for more information, contact the church office at (310) 414-4555.
1-3. From GSPC
4. Merge onto CA-60 W toward LOS ANGELES.
5. Merge onto I-605 S via EXIT 12.
6. Merge onto I-105 W via EXIT 9B.
7. Take the I-405 S exit toward LONG BEACH.
8. Take the EL SEGUNDO BLVD exit.
9. Turn LEFT onto W EL SEGUNDO BLVD.
10. Turn LEFT onto S DOUGLAS ST.
11. Turn RIGHT onto CORAL CIR.
12. 343 CORAL CIR is on the RIGHT.
343 Coral Cir, El Segundo, CA 90245-4620 Total Travel Estimate: 36.62 miles - about 43 minutes
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