Celebration Youth 2023/2024
September 2023 - August 2024 | General Permission/Parental Release Form for Celebration Youth and corresponding Events
Child's Name
*
Age
*
Grade
*
Gender
Parent(s)/Guardian(s) Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Child's Health Card #
*
Allergies/Health Concerns:
*
Emergency Contact Name
*
Emergency Contact Phone
*
Does your child have any physical, emotional, behavioural, mental concerns or limitations that staff should be aware of? If yes, please explain.
*
The safety of your Children is our primary concern. Precautions will be taken for their well-being and protection. CONSENT: I/we, the Parents or guardians named above, authorize, Tara Little, or one of Celebration Church Ministry Personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.
*
Please select all that apply.
Yes
No
TRAVEL CONSENT: i/we, the parents or guardians names above authorise my child(ren) to travel to and attend off site events. They would be allowed to travel with a youth leader or approved volunteer parent driver, to and from offsite events if driving is needed. Note: this is a blanket permission to the Friday night Youth events that will happen throughout the year. Any larger events will require a seperate form.
*
Please select all that apply.
Yes
No
I/we, named above, undertake and agree to indemnify and hold harmless Ministry Personnel, Celebration Church, and its Leaders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Celebration Church, as well as of any medical treatment authorized by the supervising individuals representing Celebration Church. This consent and authorization is effective only when participating in or traveling to events sponsored by Celebration Church.
*
Please select all that apply.
Yes
No
I/we grant permission for the reasonable use of pictures containing our Child in any or all of the following ways: website, brochures/promotional material, church, newsletters and videotaping.
*
Please select all that apply.
Yes
No
Submit
Description
September 2023 - August 2024
General Permission/Parental Release Form for Celebration Youth and corresponding Events
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