CPC Children and Youth Ministries Registration/ Permission Web Form

CPC Children/ Youth Ministry Permission Slip

  • Basic Information

  • NameRelationship to child 
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  • Allergy/ Medical Information

  • please list "none" if student does not have any allergies
  • Insurance CompanyPolicy/ Group #Policy HolderPhone 
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  • Participation Consent/ Permission

    This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the Church and its staff of any liability against personal losses of named child. I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the children and youth ministries of Central Presbyterian Church. I/We understand that there are inherent risks involved in any ministry or related event, and I/we hereby release Central Presbyterian Church, its Pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured 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 from a physician and/or hospital personnel designated by Central Presbyterian Church, 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. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided on the following page is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member.
  • Image/ Photo Consent

    I understand that photos/ video may be taken of my child during this activity. I agree that any pictures of my child taken at the activity may be included, without identifying information, in brochures and posters for promotional purposes. I also give consent for pictures of my child to be posted on the church web site and Facebook pages. *Central Presbyterian Church will abide by our Safe Church policy when posting pictures of minors.