Parent Consent Waiver

Calvary Chapel Tustin Youth Ministry

Thank You, we have received your form.

  • Age

  • Current Grade

  • Sex

  • I understand that my minor child is to be excluded from the following activies (optional):

  • Waiver

    Being the parent or legal guardian of the above mentioned student, I have been informed of the above activity sponsored by Calvary Chapel Tustin and hereby give my consent for my minor child to participate in this activity.  

    I understand that all reasonable  safety precautions will be taken by the leaders of this activity, and that the possibility of an unforseen hazard does exist.  I further agree not to hold Calvary Chapel Tustin, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the minor listed on this form.  


  • Consent to Treat a Minor

    I, being the parent or legal guadian of the above mentioned minor, consent to any x-ray, anesthetic, medical, surgical, or dental diagnosis or treatment that may be deemed necessary for my minor child.  Further, I understand that all efforts will be made to contact me prior to treatment.  In the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment.  Should there be no activity leader available, I give permission to the attending physician to treat my minor child.  I further understand that the doctors, dentists, and other providers attending to my child will take all reasonable safety precautions during their care.  


    Further, as a parent or legal guardian I am responsible for the health care decisions for my minor child and agree that my insurance plan is the primary plan to pay for the dental, medical, or hospital care or treatment that is given to my child.  Any policy of the church or organization sponsoring this event will be used as the secondary coverage.

  • Please list any food/medicine allergies and/or medications your child needs.

  • Name of physician or medical group:

  • Clear Signature