VBS Children's Consent and Release Form

Child's First Name

Child's Last Name

Gender

Grade

Allergies

Does Your Child Carry an EpiPen or other emergency medication?

Yes

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

MEDICAL CONSENT: Calvary Chapel Cherry Creek has my permission to seek medical treatment in an emergency when I cannot be contacted and to take my child to the emergency room of the nearest hospital. The hospital and its medical staff have my authorization to provide treatment which a physician deems necessary for the well-being of my child. BY LAW A PARENT CANNOT CONSENT IN ADVANCE TO ANY AND ALL MANNER OF EMERGENCY CARE. IT IS UNDERSTANDABLE THAT IN CASES OTHER THAN THE NEED FOR IMMEDIATE EMERGENCY TREATMENT, THE ATTENDING PHYSICIAN MAY DEFER TREATMENT PENDING THE PARENT’S EXPRESS PERMISSION TO ADMINISTER PROFESSIONAL SERVICE.

First Person to Notify

Relationship

Phone Number

Second Person to Notify

Relationship

Phone Number

Parent/Guardian Signature

LIABILITY RELEASE: In consideration of the acceptance of this form, I do hereby for myself, my heirs, Executors and Administrators, waive release and forever discharge any and all claims with the rights for damages which I may have or which may hereafter accrue to me against Calvary Chapel Cherry Creek, and their respective Officers, Agents, Representatives, Successor, and/or assigns any damages and liabilities which may be sustained and suffered by me in connection with, participation in, or traveling to and from any event(s). Every precaution is taken to provide a safe and fun environment for your children. By signing this form, I understand that no amount of instruction, precaution, and supervision will totally eliminate all risk of injury, and I release Calvary Chapel Cherry Creek and any authorized agents from any liability.

Parent/Guardian Signature

PHOTOGRAPHY RELEASE: Note: We may take photographs/video during activities. Since we value your child's safety, if we use these photographs/video, their names will not be used. If you do not want their pictures used do not sign below.

I hereby grant to Calvary Chapel Cherry Creek the irrevocable and unrestricted right to use any published photographs/video of me and/or my spouse and children, or in which I may be included, for any church publications, electronic reproductions (website or social media) and/or promotional materials or any other purpose and in any manner or medium. In addition, I grant my permission to alter the same without restriction; and to copyright the same. I hereby release the photographer and Calvary Chapel Cherry Creek from all claims and liability relating to said photographs/videos.

Parent/Guardian Signature

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