Generational Liability Form

If you are attending any Generational event that requires a liability form, and you currently have no file on record, just fill out each blank below, and a PDF file will be sent to the Generational Ministries Director. One per child, please.

Par/Guar First NamePar/Guar Last NamePar/Guar Email
AddressCityZip
Home PhoneEmergency Phone
Child's Information
First Name:
 Last Name:
 Gender :
Female Male		 Age :
 Grade Just Completed:
Doctor's Information
PhysicianPhysician PhoneInsurance CarrierPolicy Number
MEDICAL INFORMATION
LimitationsMedicationsAllergiesRestricted Activities

This electronic signature fully complies with the federal electronic signature statute,
title 15, U.S.C. chp 96, sec 7001, et esq and is therefore fully legal and valid as an original signature. YOU MUST CHECK THIS TO SUBMIT ELECTRONICALLY