Parental Consent Form 2026-2027

Student's Name

First NameLast Name

Student's Date of Birth

Date

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 understand that Calvary Students events may include physical activities such as, but not limited to, bowling, hiking, mini golf, sports, and large group games, as well as travel to and from off-site locations. I understand that these activities carry an inherent risk of injury, and I accept that risk on behalf of my child.

To the fullest extent permitted by law, I release and agree to hold harmless Calvary Church, its staff, volunteers, and leaders from any claims or liability arising from my student's participation in Calvary Students events, except those caused by gross negligence or willful misconduct.

In the event of illness or injury, Calvary Students staff and volunteers will make every reasonable effort to contact me. If I cannot be reached, I authorize the adult leader responsible for my child to consent to any X-ray, examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care that a licensed physician or dentist considers necessary. This authorization applies whether care is provided at a physician's or dentist's office, clinic, urgent care facility, or hospital.

I 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.

I understand my student is expected to follow event rules and leader instructions. My student may be sent home at my expense for serious or repeated behavior concerns.

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

I 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