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Student Ministries 2026-2027 Medical/Liability Release Form

Please complete for grades 6-12 only

This form is for middle school and high school students only.

This Consent Form gives permission to seek whatever medical attention is deemed necessary, and releases Christ Presbyterian Church (CPC) and all of its employees, agents, representatives and volunteers from any liability for personal losses to your student(s). Please read the following statement and sign below.

I / We, the undersigned, are the parents, the parents having legal custody, or the legal guardians of the student named below, a minor, and have given our consent for him/her to attend all activities being organized by CPC Student Ministries, including but not limited to weekday activities and offsite events. In the event that he or she is injured while attending any event and requires the attention of a doctor, I / we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required which a physician and/or hospital personnel refuses to administer without my/our consent, I / we hereby authorize CPC staff members, or another adult leader designated by them, to give consent for us, and I / we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent so long as the treatment is administered by or under the supervision of a licensed physician. I / We also acknowledge that we will be ultimately responsible for the costs of any medical care should the cost of that medical care not be reimbursed by the health insurance provider.

I / WE UNDERSTAND THAT THERE ARE INHERENT RISKS INVOLVED IN ANY STUDENTS’ EVENT, AND I / WE HEREBY RELEASE CPC, AND ALL OF ITS EMPLOYEES, AGENTS, REPRESENTATIVES AND VOLUNTEER WORKERS, FROM ANY AND ALL LIABILITY FOR ANY INJURY, LOSS, DEATH, OR DAMAGE TO PERSON OR PROPERTY THAT MAY OCCUR DURING THE COURSE OF MY / OUR STUDENT(S)’ INVOLVEMENT WITH THE 2026-2027 CPC STUDENT MINISTRY PROGRAMS.

BY SIGNING THIS FORM, I ACKNOWLEDGE READING IT AND UNDERSTANDING THE INTENT.

Please select who will be participating...
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First Student's Name
First Name*
Last Name*
First Student's Date of Birth*
Date of Birth
First Student's Signature*
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
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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