Parents Day Out Release Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Each child must have a release form filled out. Not much work for 5 hours of free childcare!

Name *

Age *

Date Of Birth *

YYYY

Phone Number *

Full Address *

In case of an Emergency Notify (Name, Number, Relation to Child): *

Family 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

Reminder: Those picking up a child must have the ticket given to the guardian at drop off. *

Understood

Reminder: One form needs to be submitted for each child attending. *

Understood

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms