2026-2027 Youth EDGE Waiver

2026-2027 Youth EDGE Waiver
Email
example@example.com
I, (parent/ legal guardian)
Parent/ Legal Guardian Name

First NameLast Name
hereby grant consent for
Child's Name

First NameLast Name
Child's Name

First NameLast Name
Child's Name

First NameLast Name
Child's Name

First NameLast Name
to attend trips and other scheduled supervised on-site and off-site program activities as part of Colonial Hills Baptist Church's programs.

I understand that the trips and activities will be to various venues from August 2026-August 2027.

I understand that supervision will be provided by Colonial Hills Baptist Church's staff and/or volunteers.

I further grant consent for Colonial Hills Baptist Church to arrange to transport the above-named child(ren) in agency-approved transportation or by any commercial carrier to all field trips and scheduled off-site program activities.

By signing this consent, I agree to hold Colonial Hills Baptist Church and its agents, staff, employees, officers, and trustees harmless from any liability or claim arising out of, or related to, the above-named child(ren)'s participation in the program and activities.

In the event of a medical emergency, if the staff of Colonial Hills Baptist Church is unable to reach me or the emergency contact listed below, I hereby give consent for Colonial Hills Baptist Church to seek, authorize, and obtain medical treatment for the above-named child(ren).
Emergency Contact Name:

First NameLast Name
Emergency Contact Phone Number:

Area CodePhone Number
Family Physician Name:
Family Physician
Family Physician Phone Number:

Area CodePhone Number
By providing your signature below, you will be providing your electronic signature.
Parent/ Guardian Signature:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent's Name:

First NameLast Name
Family Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: