CBC Children’s Ministry Form

Child's Information

Parent or Guardian Information

Medical and Emergency Contact Information

Child Release Information

Please list individuals authorized to pick up your child from CBC Children's Ministries

Activity Information

Important Notices and Information

For the safety of all children, we reserve the right to limit this ministry to any child based on the ability of Calvary Bible Church staff and/or volunteers to properly ensure his/her safety and the good health of all involved due to their special physical, mental, behavioral or emotional needs and the limited resources available within this facility. You will be contacted and asked to immediately attend to your child in the event of the following: bathroom or toileting accident, illness, injury, behavioral difficulty or any other issues deemed appropriate.
I agree


In consideration of the child’s participation in ministries and activities, as well as transportation to and from ministries and activities of Calvary Bible Church located at 603 Wilson Ave. Hanover PA 17331 I, individually and on behalf of any other parent or guardian of the child named agree to release, indemnify, defend, and forever discharge Calvary Bible Church, the board of elders, employees, paid staff, volunteer staff, and all representatives of and from any and all claims, losses, injuries, (up to and including death), demands, rights, and causes of action which may result from participation of the child. I/We know that children may be injured, sometimes seriously, up to and including death. I/We certify that the child named is physically and medically able to participate in the activities (except as noted) and related activities to the best of my/our knowledge, information, and belief. In the event of an emergency, every effort will be made to immediately contact the parent or guardian at the phone number(s) listed. If I/we cannot be reached at the phone number(s), I/We give permission to the physician selected by Calvary Bible Church to hospitalize, secure proper treatment for and order injection(s), anesthesia, or surgery for the child as the physician(s) sees fit. I/We release Calvary Bible Church, and their employees, volunteer and paid staff, affiliates, representatives, directors, elders and officers for any medical treatment provided hereunder. I/We agree to be completely responsible for any and all treatment and related costs for medical and dental services provided pursuant hereto. Appropriate photographs and/or video recordings may be taken of the child while participating in any related activities. These photos and/or video recordings may be published in Calvary Bible Church’s materials such as in/on bulletin boards, flyers, mailers, web site, and the like with no personal information listed. I/We give our permission to Calvary Bible Church to use such photos or recordings and release and hold harmless Calvary Bible Church for any action taken as stated herein, from any and all claims, losses, or injuries which could or may result from such publications, including from any acts of negligence or carelessness related thereto.
By submitting this form and selecting the checkbox below, you are verifying that you agree
to the above information and are a parent/legal guardian of the child named.
I agree

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