SUNDAY SERVICE
8:30 AM, CHAPEL: CONTEMPLATIVE
10:00 AM, SANCTUARY: TRADITIONAL

youthmissiontrip

July 28 - August 4

Students will be traveling to Mexico this summer to build a house with Amor Ministries. This trip is open to students who have completed 8th -12th grade by June 2018. Contact Brie with any questions.

Register your student now! 

2018 Mexico Mission Trip Medical and Liability Waiver Form

Please fill out the form below. If you have any questions, feel free to email Director of Children & Family Ministries, Brie Johnson

Student Info:


Parent Info:


Emergency Contact


Medical Insurance

Medical Information

Are there any physical limitations/health history that would affect the ability for your student to participate in any Youth Activities?
List All Medications (Prescribed & OTC) and reason for medication.

Special Needs/Concerns (i.e. diabetes, asthma, epilepsy, etc.)

(Please initial that these photocopies are attached to this form if applicable)

*Please include photocopy of your student's:


I give permission for my student to participate with other youth and adults from First Presbyterian Church of Livermore (FPCL) at the event listed on this form.
I understand that my child will be sent home at my expense if they are found with any drugs, alcohol, tobacco, or weapons. I also understand that my child will be sent home at my expense if they are behaving in a way that is harmful to themselves, harmful to others, or involves destruction of property.
I agree that my child will abide by the rules and regulations governing the activities and will obey any instructions given by the person(s) having supervision and control of activities.
In the unlikely event of an emergency, I give permission for my student to be treated by an accredited physician in an approved emergency clinic or hospital. I designate the adult leaders for the group with the authority to act on my behalf and order appropriate treatment. I further release from any liability the San Francisco Presbytery (SFP) and FPCL and its officers and approved emergency clinic leadership, in the event of any accident en route during and returning from these events.I expect to be contacted as soon as possible.
*If we cannot provide proof of medical insurance, my name in this form acts as my signature for the waiver releasing liability below.


I agree that all of the information above is accurate and current.


NOTE: Please complete and sign ONLY IF YOU DO NOT have medical insurance for your student.
I understand that by my child attending any youth events that FPCL and SFP will not be responsible for any emergency medical expenses incurred.
I also understand that FPCL and SFP will not be held liable for my child's actions that might involve a lawsuit.

Student Agreement

I agree to follow the following rules during the entirety of the event.
I will not bring any drugs, alcohol, tobacco or weapons to the activity.
I will not behave in a way that is harmful to myself or others.
I will respect myself, other students and leaders of the activity.
I will follow the instructions of the leaders of the activity.
I will follow the rules and regulations of the activity.