I give permission for my son/daughter, whose name is listed here, to receive emergency medical treatment in case of any accident or medical emergency. I will not hold the church, Eagle’s Nest, or any attending tutor/staff member/parent volunteer responsible for any accident or injury.

Insurance Provider

Policy Number

Emergency contact number where EN staff or medical personnel can reach you:

Additional emergency contact name:

Additional emergency contact phone number:

List any allergies, illnesses, medical conditions, or other information about this student that would be helpful in an emergency:

Parent/Guardian Email Address: