Minor-Event_Release (1) (1)

Calvary Chapel Old Towne
221 North Waverly Street
Orange, Ca 92866
714-997-2811

Minor Consent and Hold Harmless Form
(This form should be completed for each increased risk offsite event and a copy should be taken on each trip)
Name of Activity
Date Of Activity

MonthDayYear
Date
Child's Name
Child's Date of Birth

MonthDayYear
Date
Sex
Child's Address
Phone Number
I, (Parent/Guardian Name), being the parent or legal guardian of the aforementioned minor have been informed of the above activity sponsored by Calvary Chapel Old Towne and hereby give my consent for my minor child to participate in this activity
I understand that all reasonable safety precautions will be taken by the leaders of this activity and that the possibility of an unforeseen hazard does exist. I further agree not to hold Calvary Chapel Old Towne, its leaders, employees, and volunteer staff liable for damages, losses, disease, or injuries incurred by the aforementioned consenter.
I also request that my minor child may be excluded by the following activities:
Parent's Signature

Clear
Date Signed:

MonthDayYear
Date
Should be Empty: