Youth Group Emergency Release Form


Effective: September 1, 2017 to August 31, 2018


Please Print:

Please type a number (6, 7, 8, 9, 10, 11, 12) only
* Gender:
Please type a number (6, 7, 8, 9, 10, 11, 12) only
2. Gender:
Please type a number (6, 7, 8, 9, 10, 11, 12) only
3. Gender:
4. Gender:

This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the church, its staff and volunteers, of any liability in regards to the named child(ren).


I the undersigned have legal custody of the student named above and have given my consent for him/her to attend events being organized by Crossroads Evangelical Church. I understand that there are inherent risks involved in any youth ministry activity or event and hereby release the church, its staff and volunteers, from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my child(ren)’s involvement. In the event that he/she is injured and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a physician. I affirm that the health insurance information provided above is accurate at this date and will, to the best of my knowledge, still be in force for the student named above.

Media Release: I hereby give permission for my student(s) to be photographed or videotaped by Crossroads Evangelical Church during youth group activities. I will allow my student's image to be used on Crossroads Youth group Facebook and Instagram pages