Name *

First Name

Last Name

I give my child permission to attend the This Generation program at New Covenant Church of Palmyra located at 695 E. Ridge Rd. Palmyra, PA. Please Choose ONE:

Yes, My child may attend the HIGH SCHOOL program

Yes, Yes, My child may attend the MIDDLE SCHOOL program

Students grade level: Please choose ONE

6th

7th

8th

9th

10th

11th

12th

I give permission for This Generation to use photos/videos of my student in print or electronic medias for publicity purposes. *

Yes

No

Transportation will be provided by NCC for students attending the Palmyra Middle School and High School. I give permission for my child to be transported by NCC and understand that seat belts must be worn at all times. *

Yes

No

I understand that NCC does not provide transportation for Homeschool/Cyber school students. Transportation is the sole responsibility of parent/guardian. *

Yes

No

In the event of an emergency, I understand that every effort will be made to contact me. I consent to any deemed necessary medical examinations and treatment until I can be reached. I agree to pay all costs and expenses incurred in connection with those services. *

Yes

No

I do release, acquit, and forever discharge and covenant to hold harmless and indemnify NCC, This Generation, and their respective representatives, pastors, employees and volunteers from any and all liability, claims or damages arising out of any accidents , sickness, or treatment thereof incurred by said student during participation in This Generation. *

Yes

No