2025-2026 Studentlife Health & Liability (Please Fill Form Out With Student's Info)

This form is valid for all events happening between September 1, 2024 - August 31, 2025. Please fill this form out with your child's information.

Your name *

Email address *

Household members

Please select + Add Child

Address *

Phone Number *

Photo Opt Out *

I do not want pictures or videos of my student used in current or future print or online promotions.

Yes (no photos used)

No (photos may be used)

Permission to Carpool *

I give permission for my student to carpool with an adult associated with Brooklife Church.

Yes

Insurance Coverage

Please provide the following insurance information.

Medical Insurance Company *

Insurance Policy Number *

Name of Insured *

Parent/Guardian's

Parent/Guardians Full Name(s) *

Email Address *

Cell Phone *

Emergency Contact Full Name and Relation *

Emergency Contact Cell Phone *

Medical

Does You student have any medical concerns? *

Yes

Medical Concerns

List and describe any special medical conditions, restrictions, or needs this student may have and, of which, staff members need to be aware.

Allergies

Medication

Medical Release *

Parents please read & sign:

Brooklife Church’s policy is that families are responsible for any medical or health related issues or emergencies that arise on any trip. We encourage you to:
1. Ensure that your health insurance is up to date.
2. Understand that you are responsible for any medical or health related issues.
3. Sign this form releasing Brooklife Church and indicating your responsibility for these issues.
4. The purpose of this medical release is so that in case of any minor mishap, the individual could be given immediate medical attention rather than requiring parental permission before care is given. Attempts will be made to call parents should hospitalization or medical treatment be required.

FULL NAME - By entering your full name below, you have read and agree to the Medical Release statement.

Release from Liability *

I/We release Brooklife Church and its representatives from and in connection with any claim brought by anyone arising out of all sponsored trips, retreats, and or on/off premises meetings.

I/We further give permission for any medical treatment deemed necessary while said student is under the care of Brooklife Church and its representatives as a participant. If participant is under 18 years of age, please have parents complete the following.

FULL NAME - By entering your full name below you have read and agree to the Release From Liability statement.

Please Be Sure to Read

For your information, we expect each student to comply with these rules of conduct:
1. Respect property
2. Respect one another, staff, and adult leaders
3. Respect and comply with event schedules and rules.
Students who fail to comply with these expectations may be sent home at their parents’ expense.

Activities may include, but are not limited to: cookouts, bonfires, boating, swimming, sports/games, broomball, ice skating, camping, skiing, snowboarding/snowshoeing, tobogganing, tubing, paintball, concerts, Bible studies, hiking, miniature golf, hayrides, lock-ins, rock climbing, mission trips, service projects, small group trips, sleep-overs, conferences, & more.

Note: If you desire to limit your child’s participation in any event, please submit your wishes in writing to Brooklife Church prior to the event.