Calvary Bible Church 2025 Medical Release

Calvary Bible Church 2025 Medical Release
Name*

First NameLast Name
My child is involved in: (select 1)

Children's Ministry (Birth through 6th Grade)Junior High Ministry (7th & 8th Grade)High School Ministry (Freshman-Senior)
Email*
example@example.com
Birth Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Allergies:
Medical Conditions (asthma, diabetes, hemophilia, epilepsy etc.)
Medications Instructions
Type
dosage
Health Insurance Co.*
Doctor
Doctor's Phone
Policy #
Group/ID#
Policy Holder's Name
Policy Holder's DOB
Parent/Guardian Name
Parent/Guardian Phone
Please enter a valid phone number.
Parent/Guardian Email
example@example.com
I authorize any person connected with CALVARY BIBLE CHURCH, or any activity or event, to administer first aid to the participant, as they deem necessary. I authorize medical and surgical care and transportation to a medical facility or hospital for treatment necessary for the participant’s well-being, at my expense. I authorize the supervisors in the youth department to carry out any discipline deemed necessary for my child. I also agree, if necessary, that I will pay the expenses of my youth being sent home because of a disciplinary action.

I HAVE READ, UNDERSTAND, AND VOLUNTARILY AGREE TO THIS MEDICAL RELEASE, AND I VERIFY THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE MINOR, AND I HAVE AUTHORITY TO ENTER INTO THIS AGREEMENT ON HIS/HER/THEIR BEHALF.
Parent/Guardian Signature*

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CALVARY BIBLE CHURCH,

2025 Photo Release

I authorize any person connected with CALVARY BIBLE CHURCH, or any activity or event, to post group photos of events and activities that I or my child may be in on the Calvary Bible Church website and possibly various social media sites connected to Calvary Bible Church.
Parent/Guardian Signature

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