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Permissions*

I hereby give permission for Me/My Child to participate in Calvary Community Church (CCC from here out) activities and consent and agree to not hold CCC, their volunteers, or their employees liable for injury claims that I/My Child might have arising out of My/My Child’s participation in attending CCC activities.

Passenger Waiver of Liability*

I recognize and acknowledge that Me or My Child may from time to time travel as a passenger to or from CCC activities in a privately-owned vehicle driven by a legally-licensed adult driver. I consent to the vehicular arrangements and decisions made by the supervisors of any CCC activities. I understand the risks associated with travel and I agree that CCC, its volunteers, or its employees will not be held responsible for unforeseen schedule delays due to traffic or other circumstances, nor from harm or injury relating to accidents or issues on the road that might occur.

Medical Liability*

In addition, I authorize and consent to all medical, surgical, psychiatric, services that should arise if I/My Child is unreachable or unresponsive. I hereby authorize that life saving medical procedures be applied to Myself/My Child without prior consent. CCC leaders and volunteers are not holding to contact the legal guardian/spouses prior to treatment taking place. While CCC leader’s ideal practice is to inform parents of medical procedures and injuries prior to medical attention there are occasions where it is in the best interest of Myself/My Child to waive my right to in-formed consent for each treatment.

Financial Liability*

If it should become necessary for Me/My Child to receive medical treatment for any reason, I understand that CCC is not held responsible for any and all financial obligations pertaining to and resulting from Myself/My Child. I accept full responsibility for the cost of medical treatment for any injury not covered by Myself/My Child’s insurance.

Supervisor Consent*

Moreover, I understand that temporary, emergency measures may be necessary to safeguard Me/My Child’s health and do hereby authorize and request CCC leadership and their volunteers to supervise until such time as the legal guardian can be safely transported to a doctor or hospital if necessary.

Over the Counter Treatment*

In addition, I give permission for Myself/My Child to be given over-the-counter medication as needed and as directed on the label, to treat non-emergency medical conditions that do not require a doctor or hospital visit such as a minor headache, stomachache, or allergic reaction (i.e. Tylenol, Advil, antacids, Benadryl) while at a ministry event. 

Photography and Videography Consent*

Photography and videotaping may and or will take place at or around events for documentation and for future event promotion. By signing, I give consent to CCC to use any photos or video that includes me or my child for its publication, promotion, or documentation.

Acknowledge Reading of Consent Form*

By marking below, I acknowledge that I have read and agree to the foregoing. I fully understand its contents, understand that this agreement expires 12 months from July 31, 2022. I am over the age of 18 and have legal capacity to sign the release for the minors listed.


SUBMIT

CANCEL






First Student Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Student Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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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