CCC VBS 2021 Release Form

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Each child must have a release form filled out.

First and Last Name *

Age *

Date Of Birth *

YYYY

Address *

Emergency Contact - Name, Number, and Relation to Child *

Appropriate Physician and Medical Policy Information *

Medical issues to note: *

Food Allergies: *

Current Medical Concerns? *

My permission is granted for Christ's Christian Church, Pastor(s), Elder(s), and other staff personnel or other adult(s) in charge to obtain necessary medical attention in case of sickness or injury to my child. *

Yes

I, by the submission of this form, verify the given information above is correct and release and discharge Christ's Christian Chruch and all sponsors from any and all claims, demands, actions or causes of action, past, present, or future arising out of any damage or injury while participating in a church-sponsored youth activity. *

Yes

One form needs to be submitted for each child attending. After the submission of this form, you'll have the option to return to a fresh form for additional children. *

Understood

Submit

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