2024/2025 Van Consent Form & Liability Waiver

Please complete this entire form to register your child/children for the Sunday van and ministry activities with the Contact Mission Church of Christ! It should only take a few minutes.

Parent or Guardian Info

Name

This address will receive a confirmation email

Phone

Address

Birthdate

Gender Male Female

If you have medical insurance, who is your provider?

I hereby give my permission for all the children listed above to ride the van/bus, participate in activities, and attend Contact Mission Church of Christ or any of the church related functions. I understand that my children will be under adult supervision. I further understand that in signing this permission slip, I release and hold harmless Contact Mission Church of Christ and all other church-related functions. By signing this permission slip, I release and hold harmless its trustees, officers, employees, and any volunteers from any liability, past or future, fully and completely. I authorize the staff or designated medical professionals and/or volunteers to administer emergency medical assistance if I cannot be reached. I understand that my child(ren)’s photo may be taken and used in printed publications, website or social media by Contact Mission Church of Christ, and that I may contact the church office in writing to revoke this permission.

Yes No

Emergency Contact Information

Emergency Contact's Name

Emergency Contact's Phone Number

EC's Relationship to Children

Children's Information

Fill out separate info for each child

Child 1 Name

Child 1 Birthdate

Child 1 Gender

Male Female

Child 1 Allergies & Medications

Child 2

Scroll to bottom if no more children to register

Child 2 Name

Child 2 Birthdate

Child 2 Gender Male Female

Child 2 Allergies & Medications

Child 3

Scroll to bottom if no more children to register

Child 3 Name

Child 3 Birthdate

Child 3 Gender Male Female

Child 3 Allergies & Medications

Child 4

Scroll to bottom if no more children to register

Child 4 Name

Child 4 Birthdate

Child 4 Gender Male Female

Child 4 Allergies & Medications

Child 5

Scroll to bottom if no more children to register

Child 5 Name

Child 5 Birthdate

Child 5 Gender Male Female

Child 5 Allergies & Medications

Child 6+

If you have more children to register, please include their names, birthdays, gender, and any allergy or medical information here.

Additional Children

2024/2025 Van Consent Form & Liability Waiver

Description

Please Fix the Following