Parental Consent Form 2026-2027

Parental Consent Form 2026-2027
Student's Name

First NameLast Name
Student's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student's School and Grade
Parent/ Legal Guardian's Name

First NameLast Name
Parent/ Legal Guardian's Email
example@example.com
Parent/ Legal Guardian's Phone Number

Area CodePhone Number
Best Way to Communicate with Parent/ Legal Guardian

Other
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Medical Information
Allergies (including food allergies) or Medical Conditions
Family Insurance
Insurance Company
Policy #
Group #
I, the undersigned parent or legal guardian do hereby give permission for my child, ____________________, to attend and participate in Calvary Students events from September 2026 - August 2027.

I authorize an adult, in whose care the minor has been entrusted, to consent to any temperature checks, x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to the minor due to the general or special supervision and on the advice of any physician or dentist, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my child) to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs.

The undersigned does also hereby give permission for my child to ride in any vehicle designated by the adult in whose care the minor has be entrusted while attending and participating in events sponsored by Calvary Students.

The undersigned does also hereby give permission for photo and video of my child to be posted to calvaryweb.net, Calvary Student’s Facebook page, or related social media accounts.
Student Signature
Parent/Legal Guardian Signature
Should be Empty: