Effective: September 1, 2017 to August 31, 2018
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.