Calvary Kids Sports Camp Sign Up & Activity Consent

Child’s Information

Child's First & Last Name

Date of Birth

Age

What grade is your child in?

Address

Parent(s)/Guardian(s) Name(s)

Phone

Which sport will your child be participating in?

Liability & Consent

Liability Release and Consent for Treatment in the unlikely event that my child is injured while participating in activities at Calvary Chapel Church- Calvary Kids Ministry in route to such activities, my child and I relinquish all rights to recover damages for any and all injuries sustained by my child. In consideration for Calvary Chapel Church-Calvary Kids Ministry granting my child permission to participate in Calvary Kids Ministry activities, I hereby release Calvary Chapel Church, its employees and volunteers from liability or injuries occurring in Calvary Kids activities.

In case of emergency, I hereby authorize Calvary Chapel Church-Calvary Kids Ministry to contact emergency personnel and release pertinent personal information so that my child may receive treatment.

Liability Release, Consent for release of information and for treatment (choose one)

Yes No

List allergies, medical or other special conditions we should be aware of:

Will your child be carrying an epi-pen?

Yes No

Emergency Contact

Contact Name #1

Phone

Does this person have permission to pick up your child?

Yes No

Relationship to Child

Contact Name #2

Phone

Does this person have permission to pick up your child?

Yes No

In case of emergency (when the parent/guardian cannot be reached) who may we contact:

Name

Phone

Relationship to Child

Does this person have permission to pick up your child?

Yes No

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Permissions/Authorizations

I give permission for my child to be transported in a vehicle:

Yes No

I give permission for photos to be taken of my child participating in activities. I understand that the photos and/or video may be used on all our communication platforms such as but not limited to website, social media outlets, etc.

Yes No

By typing your name below you acknowledge that you have read and completed the above information:

Full Name of Parent/Guardaian

Payment $10

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Calvary Kids Sports Camp Sign Up & Activity Consent

Description

Please Fix the Following