Youth Ministries Parental Release Form

I, the undersigned, being the parent / legal guardian of the minor child named below, do hereby give permission for my child to participate in Youth Group Events through Christ Presbyterian Church.

I certify that I am cognizant of the inherent dangers associated with participating in the activity; that there is some element of risk in participation and that the activity may take place off and on church property. To this end I agree that neither Christ Presbyterian Church, its elders, representatives, instructors, agents, nor chaperones will be held liable for any injury or illness, which may result in harm or other damages.

I authorize Christ Presbyterian Church and its representatives to render or obtain such emergency medical care / treatment as may be necessary should injury, harm or accident occur to my child while participating in this project.
I further state that I am of lawful age, legally competent, and the legal parent / guardian of the below noted child. I understand the terms noted herein are contractual and are not merely recital, and that I have signed this document of my own free act and volition. I further state and acknowledge that I have fully informed myself of the contents of this affirmation and release by reading it before I have signed it.

Youth first name:*
Youth last name:*
Home phone:*
Home street address:*
Home city:*
Father's name:*
Father's cell phone:
Mother's name:*
Mother's cell phone:
Medical Insurance Company:*
Medical policy number:*
Name of emergency contact person:*
Phone number of emergency contact person:*
Important medical information (examples: medications, allergies, physical limitations)  If no significant medical information exists, please type the word "None".*
Date this affirmation is submitted:*

* Enter Your Email Address: