Activity Release Form - Student Information

You will receive an email after submitting this application. Please open the email and confirm that all information is correct.

Your name *

Email address *

Birthday *

Grade

Gender *

Phone Number

Physician Prescribed Medication

Special Needs or Considerations

(Allergies, Asthma...)

Students must have a current CFC Activity Release Form on file to attend any off campus CFC Youth Event. Individuals 18 years of age or older, parents, or legal guardians must complete this form. This must be completed annually beginning in January.

Activity Release Agreement

I consent to allow my child listed above to participate in any activity or trip sponsored by Christ Family Church. In the event of an emergency where medical treatment is necessary, I authorize the Church to obtain the services of a licensed physician or certified paramedic my child. I agree that any expense incurred will be my obligation. Please attempt to notify me immediately concerning any such emergency.

I, in my capacity as a parent or legal guardian, express a full and complete release of any liability and indemnification, past or future, which may be claimed against the Church, and its agents, trustees, officers, employees, members, attendees, representatives, any volunteers and specifically includes all claims and demands of whatever nature, actions, damages, costs, loss of services, expenses and compensation on account of or in an way growing out of personal injuries, illnesses, and/or property damage having already resulted or to result at any time in the future, whether or not contemplated at the present time or whether or not they arise following the execution of this release. For the consideration stated above. I further agree that in the event that my child or I should make any claim against the Church for damages arising out of the above named activity, we will personally indemnify, defend, and hold harmless the Church, and its agents, trustees, officers, employees, members, attendees, representatives, and any volunteers against any and all loss and damaged occasioned there by, including attorney’s fees.

This Activity Release Form will remain in effect for ALL events or activities that my child may participate in during the calendar year.

Digital Signature (Legal Guardian must sign if person is a minor - Under 18 years old) *

Date *

Insurance Information

Do you have medical insurance? *

Insurance Company

Insurance Policy Number

Insurance Group Number

Parent/Guardian Information

Emergency Contact Name *

Emergency Contact Phone

Emergency Contact Email

Image Release Agreement

I understand that Christ Family Church may take images during events and activities. I hereby give permission for my image, with or without name recognition, to be copyrighted and/or used solely for the purposes of Christ Family Church promotional and advertising material, websites and publications, whether print or electronic. This also includes provision to include statements, such as testimonials, quotes, etc. I waive any rights to ownership or compensation thereto.

This Image Release Agreement remains in effect until dated, written notice of revocation.

If the above named person is under the age of 18, I the parent/legal guardian authorize.

I agree my image may be used. *

Digital Signature (Legal Guardian must sign if person is a minor - Under 18 years old) *

Date *

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