2024-2025 Cedar Creek YOUTH Waiver

I, parent/guardian’s full name* , the parent/legal guardian of child’s full name* give permission for him/her

to participate in all events sponsored by the youth ministries of Cedar Creek Community Church from September 10, 2024 - September 8, 2025.

In consideration of the attendance of my child at the activities with youth ministries at Cedar Creek Community Church, I do hereby release and discharge Cedar Creek Community Church and all its directors, sponsors, and adult leaders acting officially or otherwise, from any and all claims, demands, actions, or causes of action on account of injury sustained by my child in these activities.

I authorize any directors, sponsors, or adult leaders of Cedar Creek Community Church to obtain emergency medical treatment for my child at any time during these activities. I understand that every effort will be made to notify me of any injury to my child before any treatment is administered. In the event that I cannot be reached, I give permission for my child to be evaluated, diagnosed, treated and/or medicated by licensed medical personnel. In addition, I grant permission for the release of any medical information which I give Cedar Creek Community Church to be given to medical personnel in case of illness.

I agree to be responsible for my child's transportation home, including in the event of disciplinary action that warrants it necessary for the dismissal of my child from any of these activities upon being notified by the adult leader/youth director. Should it be deemed necessary for my child to return home for these activities due to medical reasons, disciplinary action or otherwise, I will assume all transportation costs.

Name of Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Parent/Legal Guardian Email*

You will be added to our parent/guardian mailing list to stay up-to-date on our student ministry plans.

Student’s Health Card #*

Student’s Date of Birth*

Date

Student’s Grade in Fall 2024*

Please list any relevant medical/allergy information:

Do you acknowledge that Cedar Creek Community Church may use photography and video images of events in publicity materials such as websites, social media, newspaper, videos, and posters and, therefore, grant permission for photo/video images of your child to be taken and used for such purposes?*

YesNo

I, the under signed hereby acknowledge that I have read the foregoing and understand it.*

Yes

Parent/Legal Guardian Signature:*