Crossroads Youth Waiver Form 2025-2026

Individual Agreement/Acknowledgement of Risks
*Crossroads Community Church Youth Ministry requests permission for your student to be photographed or video recorded. These may appear on printed material or the church's website or the church's social media pages.
I agree to have my student's photo/video used as indicated above.*

YesNo
I/We (Parent or Guardian):*

First NameLast Name
Give my permission for:*

First NameLast Name
... to participate with other youth and adults from Crossroads Community Church in programs/events throughout the 2025-2026 Year. In the unlikely event of an emergency, I give my permission for my student to be treated by an accredited physician in an approved emergency clinic or hospital. I designate the adult leaders for the group with the authority to act on my behalf and order appropriate treatment. I further release from any liability Crossroads Community Church and its leaders, in the events of any accident en route during and returning from these events. I expect to be contacted as soon as possible.
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Emergency Contact Information