Parental Consent and Release for Powerhouse Youth Ministries

Family Registration Form for Calvary8Students
Name of Child/Youth:

First Name Last Name
Grade
Child/Youth's Date of Birth:

- Month - Day Year
School child Attends

Holland Heights Holland East Holland High Holland NuTech Zeeland East Zeeland West Vanderbilt Cityside Creekside Holland Christian Zeeland Christian Innoacademy West Ottawa Macatawa Bay
Medical Conditions: Please write in any we should be aware of in the box.
(2nd child/youth) Name of Child/Youth:

First Name Last Name Suffix
Grade
2nd Child/Youth's Date of Birth:

- Month - Day Year
School child Attends

Holland Heights Holland East Holland High Holland NuTech Zeeland East Zeeland West Vanderbilt Cityside Creekside Holland Christian Zeeland Christian Innoacademy West Ottawa Macatawa Bay
Medical Conditions: Please write in any we should be aware of in the box.
(3rd Child/youth) Name of Child/Youth:

First Name Last Name
Grade
3rd Child/Youth's Date of Birth:

- Month - Day Year
School child Attends

Holland Heights Holland East Holland High Holland NuTech Zeeland East Zeeland West Vanderbilt Cityside Creekside Holland Christian Zeeland Christian Innoacademy West Ottawa Macatawa Bay
Medical Conditions: Please write in any we should be aware of in the box.
Name of Parent/Legal Guardian:

First Name Last Name

Student Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent/Guardian Cell Phone Number:

- Area Code Phone Number
2nd Parent/Guardian Cell Phone Number:

- Area Code Phone Number
TRANSPORTATION PERMISSION: I give permission for my child/children listed to be transported to and from Calvary for programs and events. I release the Program staff and/or Pastoral Staff from all liability for accidents incurred on this trip so long as no church representative has been grossly negligent.

Yes No
PHOTO/VIDEO RELEASE: I give permission for my child/children's name, photograph, video, or any other work to use in Calvary publications, including those online.

Yes No
Kids and Student Covenant

Please read through the following:
Our Values:

YOU MATTER: Human beings are the pinnacle of God's creation. This means that every person has value. We want you to strive to create and support and environment where every single person is loved and valued.

WORDS MATTER: God spoke creation into existence in Genesis chapter 1, and as God's image bearers, he asked humans to name the animals (Gen. 2:19). Words have the power to build up or destroy. We want you to create and support an environment where others are built up and encouraged with your words.

RESPECT MATTERS: Respect is defined as "deeply admiring someone for their gifts, abilities, qualities, and achievements." We want you to strive to call out the good in others and respect the church's property as if it were your own.

GOD MATTERS: We're not shy about it. We are a church; one that tries representing Jesus Christ to the world. We want you to strive and support learning about our Creator, and live the way Jesus shows us, which is the best possible life to live.
EMERGENCY MEDICAL AUTHORIZATION

(If you do not sign this your child may not ever be on church premises without you.)

In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by Pastoral Staff or the Program Director(s) to hospitalize, secure proper treatment for, and to order injections, anesthesia, or surgery for my child(ren) as named. In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give the Program Director(s) permission to act on my behalf in seeking emergency treatment for my child. I also authorize any hospital which has given treatment to my child to release the child to Calvary Reformed Church and its adult staff members when treatment is completed. I also release the Program Director(s) and Pastoral Staff from all liability so long as no church representative has been grossly negligent.
Date:

- Month - Day Year
My signature below agrees to the emergency medical authorization above, as well as the Kids and Student Covenant. I agree I will do all I can to support Calvary's vision for kids and students.
Signature of Parent/Legal Guardian: *

Clear
Signature of Child/Youth (for Kids and Student Covenant

Clear
Signature of 2nd Child/Youth

Clear
Signature of 3rd Child/Youth

Clear
Photo of Child/Youth #1
Photo of Child/Youth #2
Photo of Child/Youth #3
Should be Empty:

Family Registration Form for Calvary8Students

Kids and Student Covenant