Family Waiver

Enter Child(ren) Information

	Child First Name	Child Last Name	Child Date of Birth	Child Gender
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Child First Name

Child Last Name

Child Date of Birth

Child Gender

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Calvary Church is not responsible for the loss or theft of personal belongings.

Initials

Misconduct may result in transportation home from an activity at student or his/her parents' expense. A student dismissed for a disciplinary reason will not receive a refund of the activity fee.

Initials

I hereby agree for my child, myself, my executors, administrators, heir, next of kin, successors and assigns:
a) I agree not to sue Calvary Church, its employees, staff, agents, representatives, volunteers, drivers, activity hosts, sponsors, church members, affiliates, attorneys, successors, and/or agents (“Releasees”) for any claim, loss, damage, personal injury (including injuries causing death), property damage, or the like, suffered or incurred by me or my family member(s) in connection with any activity related to Calvary Church, whether on or off Calvary’s premises, except in the case of gross negligence on the part of Calvary Church staff or volunteers.
b) I release and indemnify, defend, and hold harmless Calvary Church/Team Leaders, for any injury arising directly or indirectly from either participating in events or transportation to and from such events, whether such injury arises out of the negligence of Calvary Church/Team Leaders, the Participant, or otherwise. I hereby assume all of the risks of participating in Calvary Church Kids & Students Ministry activities.

Initials

I, the parent or legal guardian of the above named child(ren), give permission for the above named child(ren) to participate in the activities conducted by Calvary Church Kids & Student Ministry

Yes No

I, the parent or legal guardian of the above named child(ren), release Calvary Church and Releasees of any responsibilty for accidental injuries sustained to, during and from all student ministry activities.

Yes No

In case of an emergency, I, the parent or legal guardian of the above named child(ren), hereby give permission to the physician and/ or hospital to order injection, anesthesia or surgery for my child as deemed necessary by the appropriate professionals and in accordance with my child’s medical history.

Yes No

I, the parent or legal guardian of the above named child(ren) , acknowledge that Calvary Church and Releasees are not a transportation service and that they are not associated with any transportation service.

Yes No

I, the parent or legal guardian of the above named child(ren), acknowledge that Calvary Church and Releasees have made no representations relating to the safety of the activity(ies) and that I am not relying on any alleged representations by Calvary Church of any kind.

Yes No

I, the parent or legal guardian of the above named child(ren), acknowledge that Calvary Church and Releasees are not an activity sponsor or promoter.

Yes No

OPT OUT: Please check the box below if you do not give permission for your child(ren)’s image to be used in Calvary Church publications. If you do not check the box below, images and names of your child(ren) participating in Calvary Kids may be used in Calvary publications in print and online. If opting out, you must provide an updated and labeled photo of him/her to the Calvary Kids office for our files. They can be submitted to calvarykids@calvarygr.org.

Do Not Publish My Child's Photo

Opt-Out

Family Health Insurance Information

	Health Insurance Company	Insurance Policy Number	Insurance Company Phone	Ins Policy Holder Full Name	Ins Policy Holder Phone Number
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Health Insurance Company

Insurance Policy Number

Insurance Company Phone

Ins Policy Holder Full Name

Ins Policy Holder Phone Number

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By typing your full name here, you indicate your agreement with the foregoing statements.

Work Entry

Personal Information

Child(ren) Information

Parent Agreement

Parent Agreement

Family Health Insurance Information

Waiver Agreement

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