Mega Camp 2026 Parental Consent Form

Name of Mega Camp Participant*

First NameLast Name

Name of Parent/Guardian Completing the Waiver*

First NameLast Name

Parent/Guardian Phone Number*

Format: (000) 000-0000.

Parent/Guardian Email*

example@example.com

PHOTO RELEASE
This parental consent form is included to both inform you and request permission for your child’s photos/images and name to be published on the Central Assembly of God public website and related social media platforms. The law requires that we ask for your permission to use photographs and information about your child. Pursuant to law, we will not release any personally identifiable information without prior written consent from you as a parent or guardian. It is our policy to keep contact information (residential addresses, e-mail addresses and phone numbers) strictly confidential at all times. We may, however, want to include photos highlighting your child’s participation on our website, social media platforms, and other publications, and seek your permission to do so.

Please choose ONE of the options below

I/we GRANT permission for a photo/image that includes this student without any other personal identifiers to be published on the Central Assembly of God public website or other media.I/we GRANT permission for a photo/image and name to be published on the Central Assembly of God public website or other media.I/we DO NOT GRANT permission for a photo/image that includes this student or any other identifiable information (as described above) to be published by, on behalf, or on the Central Assembly of God public website or other media.

LIABILITY WAIVER

I, the parent/guardian of the participant named above, hereby give my permission for my child to participate in any/all activities and programming of Central Assembly of God located in Houston, PA. I understand that my child will be participating in activities/programming either on property/in facilities owned and operated by Central Assembly of God or elsewhere and that this agreement is not limited by location or activity. I understand the general structure of the activities/programming and do not need to be informed of each and every activity. My child being in attendance signifies my permission/consent for their participation in the activity/program.

I agree not to hold Central Assembly of God or any of its employees, volunteers, or affiliates responsible for any expenses or injuries that my child may incur while engaged in these activities. I understand that my child is responsible for his/her behavior at all times.

I agree that in the event of an injury, Central Assembly of God personnel in charge of this activity may act on my behalf in obtaining medical treatment for my child, and I agree to take full financial responsibility for treatment.

Signature of Parent/Guardian

Date signed by Parent/Guardian*

Date

Mega Camp Parental Consent Form