MFP.Youth Waiver (Harriston) • Mount Forest Pentecostal Church

WAIVER & MEDICAL RELEASE FORM

Field Trips and Special Events

Youth Rally @ Whitesroad Pentecostal Church, Harriston

Groups from around the region gathering for Games, Worship, Food and lots of fun!

April 24, 2026

*** MEET AT MFP.Church for 6:00pm, returning between 10 - 10:30pm for pickup.***

Student Information

First Name *

Last Name *

Has your student attended MFP. JR HIGH previously? *

Home Address *

Phone Number

Does your child have any Allergies, medical or behavioural concerns our staff and volunteers should know about? *

OHIP Information

The above named child is covered by Ontario Health Insurance (OHIP) or equivalent medical insurance.

Family Physician

Phone Number

Parent/Guardian Info

First Name *

Last Name *

Cell Phone Number

Email Address *

Emergency Contact

Full Name *

Cell Phone Number *

Relationship to Student(s) *

Parental Agreement

Precautions are taken for the safety and health of your child, but in the event of accident or sickness, Mount Forest Pentecostal Church, its staff, and its volunteers are hereby released from any liabiltiy. In the event that your child requires emergency treatment, you or your designated emergency contact will be notified immediately.

Full Name (Parent/Guardian) *

By checking this box, you agree with the above policies *

Yes

Date *

Electronic Signature *