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2025 SPRING BREAK COLLEGE TOUR

New United Missionary Baptist Church
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New United Missionary Baptist Church – College Tour 2025

APPLICATION

 

Part I STUDENT INFORMATION

Single choice
Male
Female

Parent Information

 Part II – STUDENT AGREEMENT and PARENTAL CONSENT


I HEREBY CERTIFY that all statements made herein, and on any attachments, are true and correct to the best of my knowledge. Submission of false information may result in non-acceptance on the College Tour. As a condition of my participation in the College Tour, I agree to abide by the rules of conduct and the guidance/directions of the Tour Coordinators/Counselors. I understand that serious acts of misbehavior on my part may result in my immediate dismissal from the Tour and return home at the expense of my parents/guardians.

 

Date

I have read the conditions. My signature below and the enclosed payment indicate that my child has my permission to participate in the College Tour. I understand that photographs of my child will be taken during the Tour and may be included in publications of New United Missionary Baptist. I agree to the scheduled payments for this tour by bank check or money order. No personal checks, cash or credit cards accepted. I understand that the no monies are refundable 14 days prior to the Tour; however, they are transferable to another student.

 

Permission

has my permission to travel by bus to tour Colleges and Universities and visit the other sites listed in the New United Missionary Baptist Church Itinerary for March 16 – March 20, 2025

 

Release

I hereby release New United Missionary Baptist Church, its staff, and volunteers from all responsibility for any injuries and/or illness to the child named above during the College tour between March 16 – March 20, 2025 and agree to indemnify, defend and hold the individual staff and New United Missionary Baptist Church harmless from all claims made by the child named above arising out of injuries, illness and/or death during this trip.

 

Date

Guardian Consent for Medical Treatment

I, authorize New United Missionary Baptist Church, its staff and volunteers to grant consent for medical treatment for this child in the case of an emergency during the College Tour, March 16 – March 20, 2025.


I give permission to New United Missionary Baptist Church, its staff and volunteers to share information relevant to my child’s health condition with appropriate personnel when needed to meet my child’s health and safety needs. I give permission to exchange information with my child’s physician/counselor for the purpose of referral, diagnosis and treatment. I assume all financial responsibility for medical costs arising from emergency medical care over and above costs covered by the personal insurance benefits provided by me for the child named above.


I give my permission for New United Missionary Baptist Church, its staff and volunteers to administer Acetaminophen/Ibuprofen to my child.

 

Permission
Yes
No
Date

Emergency Contact

Please Check All That Apply

Does Your Child Have An EpiPen?
Yes
No
Hearing Problem
Right Ear
Left Ear

Emergency and Hospitalization Insurance

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Fill out the 2025 application. Once completed, hit the submit button
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You may also download the application below

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CHURCH ADDRESS

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2629 Tunnel Blvd.
Chattanooga, TN 3
7406

Tel: 423-629-2875

Fax: 423-468-3507

Email: office@newunited.org

 

www.newunited.org

CONTACT US
 

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