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Youth Mission West Virginia 2022 on Friday, June 3, 2022

HS Youth Mission Trip to West Virginia

Dates for Rising 12th Graders:  June 3-10

Dates for Rising 9th - 11th Graders: June 5-10

Cost: $700


Please fill out the form below.
*First Name of Youth Participant:
Middle Name:
*Last Name of Youth Participant:
*Gender:
*Date of Birth (mm/dd/yyyy):
*Emergency Contact Information #1 (List Name, Relationship, and Phone #)
Emergency Contact Information #2 (List Name, Relationship, and Phone #)

Health Insurance Information

*Health Insurance Provider:
*Policy and/or Group Number:
*Full Name of the Insured:

Medical History

List any medical restrictions/disabilities and medicines taken (dosage details):
List allergies (including food):
Date of last tetanus shot:
If you are not an active participant at First Presbyterian Nashville, please indicate the best time/s for a phone interview.

Team Covenant

First Presbyterian Church sponsors various activities for its youth. I give permission for my child to participate in any Church-sponsored activity that my child attends. I further give permission for my child to ride with a driver age 18 or older to and from those activities. I understand that with any activity, including transportation, there is the chance of injury to person or damage to property and that with any activity, there is the risk of multiple types of infectious disease, including one caused by a coronavirus, such as COVID-19. Notwithstanding the risk, I release, relieve, and hold harmless First Presbyterian Church, its employees, members, and volunteers (including drivers) from any and all liabilities, including liability resulting from injury to person or damage to property or from contracting a contagious disease, arising out of my child's participation in a Church-sponsored activity, including transportation provided by a driver age 18 or older. Further, in the event my child is injured at a Church activity and requires medical treatment, I give permission to any adult leader (age 18 years or older) to authorize such medical treatment as he or she determines appropriate in consultation with medical professionals, and I agree to be financially responsible for such medical treatment. It is not unusual for youth to ride with their peers who are licensed to drive. I understand and agree that the Church does not and will not accept responsibility for injuries or damages resulting from my child riding with their peers to or from Church activities. I agree to be responsible for transporting my child to and from church functions if I do not want them riding with their peers. I understand that he/she may be photographed, and that these photographs may be included in publications, social media posts, and web sites of First Presbyterian Church of Nashville.

The signature below affirms that this covenant is committed to by :
*Digital Signature 1 (First, Middle Initial, Last):
If participant is a child or youth, parent signature is requested below:
Digital Signature 1A (First, Middle Initial, Last):

Trip Cost and Member Agreement

The trip cost is payable to First Presbyterian Church. I agree to fulfill all financial requirements in accordance with the payment schedule established for this mission service opportunity and if my personal circumstances change, I agree to notify the Youth Office immediately to make alternate arrangements. I understand that my failure to provide necessary documents and payments as agreed could affect my ability to participate in this youth opportunity. All or a portion of my payment is considered a donation, and if I cancel the trip, the funds may not be refunded. If for some reason FPC has to cancel the trip, all payments will be refunded.

By signing below, I agree to the above terms and understand that completing this form does not guarantee my participation as a member of the team for which I am registering.:

*Digital Signature 2 (First, Middle Initial, Last):

 Financial Assistance
If you need financial assistance, please contact Adam DeVries at Adevries@fpcnashville.org.:







Questions?

If you have questions regarding the trip, please contact Ginger Sheppard, 615-298-9570, or youth@fpcnashville.org.
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