Youth Parental Permission Form

This form grants permission for your youth to participate in various activities and programs. Please take a moment to fill it out completely.

Your name *

Email address *

Household members

Address *

Phone Number *

Birthdate *

Grade *

School *

Gender

Note

Consent & Permissions:

Parental/Guardian Consent *

I/we, the parents or guardians named above, grant permission for the above named student to attend Youth events, activities and programs or as stated above.

Photography *

Periodically we will capture moments at our events with pictures or video for the use of things like future event promotion, church information slides, etc. Typically with students these are group shots for things like day camps, etc. By selecting “yes” you are giving permission for your student to be included in these photos. No names of students are included or visible in any publication. If you have further questions please contact us at office@cpclife.com. Thanks!

Yes

Medical Consent *

I/We, the parents or guardians named above, authorize the ministry staff of Comox Pentecostal Church to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

Legal *

I/We, the parents or guardians named above, undertake and agree to indemnify and hold blameless the ministry staff, Comox Pentecostal Church, its Pastors, Leadership Council, directors and employees from and against any loss, damage or injury as well as any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in or traveling to events of the Comox Pentecostal Church.

Parent/Guardian name who filled out this form *

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