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YOUTH
TRINITY YOUTH MINISTRIES
STUDENT LIABILITY RELEASE FORM
7th - 12th Grades
PARENT/GUARDIAN INFO
MOTHER/GUARDIAN NAME:
*
Phone:
*
Email
*
Address
*
FATHER / GUARDIAN NAME:
Phone
Email
Address
EMERGENCY CONTACT INFO
Contact Name:
*
Phone
*
Relationship to participant
*
MEDICAL/HEALTH INSURANCE INFO
Person Insured:
*
Insurance Company:
*
Policy #:
*
Group #:
Doctor:
*
Doctor's Phone #:
*
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VISIT TRINITY
VISIT TRINITY
WHO WE ARE
TOUR TRINITY
WEDNESDAY NIGHTS
CENTENNIAL CELEBRATION
STAFF
REV. CRAIG HAUSCHILD
REV. DR. KIM BIERY
FAYE SUMMERVILL
KERRIE OLLENBURGER
RANDY DOERKSEN
SARAH JANE SEIFRIED
TONYA DEAL
VALLI DAWN BOOE
BARB NICKELS
DEANA RINEY
CHRIS AKINS
SARAH HAWORTH
JERRY WILLS
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