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2019-2020 Events

Gaga Ball, Basketball, Soccer, Football, 9-Square, Group Games in Sanctuary, Inflatables, WHIRLYBALL, Pumpkin Olympics, hay rides with horse carriages, petting zoos with live animals, Flannel Falooza, Misfit Thanksgiving, Turkey Bowling, Christmas Tree Pagent, Christmas Party, Riding in provided transportation to events, go karts, bowling, outdoor laser tag, fall retreat - Collide, winter retreats - Snowbound and Snow Camp, INSOMNIA - gokarts, bumper boats, laser tag, bowling, silent disco, photo booth and any activities at Boondocks, volunteering at local mission organizations including Children's Hospital, nerf gun battles, bump soccer, student leader trips, bowling at bowling alley, traveling in 15 passenger vans, traveling in charter buses, traveling in approved leader vehicles, Mission Camp at Glorieta which includes lake swimming,  yardwork, building houses and provided camp recreation activities, Overseas Mission Trip and all activities included, Splatter Paint Party, etc.

 

 

WE RELEASE LIABILITY FROM ANY AND ALL ACTIVITIES INCLUDING BUT NOT LIMITED TO  Gaga Ball, 9-Square, go karts, outdoor laser tag, nerf gun battles, whirlyball, bowling, Travel to and from all events by provided church transportation, Retreat activities including dodgeball, rope courses and leap of faith, putt putt golf, Ranch Work/Farm Work, Pulling Weeds, Building Fences, feeding animals, working at nursing homes, sitting on couches in random places, ziplines, Working with Homeless in Denver, turkey bowling, games on Sunday nights in Sanctuary, all sports played on church property, splatter paint party, overseas mission trips, etc. 

With the increasing sophistication of our medical systems, it is most helpful to have parental release forms in the unlikely event of some serious injury requiring medical treatment. This release gives the adult youth leader permission to take your child to the nearest medical facility and have the necessary treatment administered. Many hospitals will not administer any medical attention to a minor without some parental consent.

Therefore, would you please read the statement in capital letters and sign below. All this does is give us the permission to seek whatever medical attention we deem necessary.

IN CASE OF EMERGENCY, I UNDERSTAND THAT EVERY EFFORT WILL BE MADE TO CONTACT ME. IF I CANNOT BE REACHED, I HEREBY GIVE THE PLUM CREEK CHURCH YOUTH LEADER THE PERMISSION TO ACT IN MY BEHALF IN SEEKING EMERGENCY TREATMENT FOR MY CHILD IN THE EVENT SUCH TREATMENT IS DEEMED NECESSARY. I GIVE PERMISSION TO THOSE ADMINISTERING EMERGENCY TREATMENT TO DO SO, USING THOSE MEASURES DEEMED NECESSARY. I ABSOLVE PLUM CREEK COMMUNITY CHURCH FROM LIABILITY IN ACTING IN MY BEHALF IN THIS REGARD SO LONG AS THEY ARE NOT GROSSLY NEGLIGENT. PLUM CREEK COMMUNITY CHURCH IS NOT RESPONSIBLE FOR EXPENSES INCURRED AS A RESULT OF INJURY OR ILLNESS DUE TO AN ACCIDENT OR NATURAL CAUSES.

PHOTO RELEASE: I hereby give permission for Plum Creek Church to video or photograph my son/daughter or myself for all church sponsored events unless this clause is non-agreeable and written notification is given to the Plum Creek Church office at 960 S. Interstate 25, Castle Rock CO 80104.

 

First Student's Name

First Name*

Middle Name

Last Name*

Phone*
First Student's Date of Birth*
First Student's Signature*
Second Student's Name

First Name*

Middle Name

Last Name*
Second Student's Date of Birth*
Third Student's Name

First Name*

Middle Name

Last Name*
Third Student's Date of Birth*
Fourth Student's Name

First Name*

Middle Name

Last Name*
Fourth Student's Date of Birth*
Fifth Student's Name

First Name*

Middle Name

Last Name*
Fifth Student's Date of Birth*
Sixth Student's Name

First Name*

Middle Name

Last Name*
Sixth Student's Date of Birth*
Seventh Student's Name

First Name*

Middle Name

Last Name*
Seventh Student's Date of Birth*
Eighth Student's Name

First Name*

Middle Name

Last Name*
Eighth Student's Date of Birth*
Ninth Student's Name

First Name*

Middle Name

Last Name*
Ninth Student's Date of Birth*
Tenth Student's Name

First Name*

Middle Name

Last Name*
Tenth Student's Date of Birth*
Student's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive student ministry information by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Health Information

Additional comments regarding medical history, allergies, current medications, penicillin or drug reactions, etc., which may be needed in the course of any treatment:
Health Insurance Information

Insurance Company Name *

Insurance Company Address *

Insurance Company Phone # *

Policy # *

Group # *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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