The following release form will cover Connection Point Students’ activities from January 1st, 2024 until January 1st, 2025. Unless your information changes, you only need to complete this online form one time each year.
This form is to be filled out ONLY by the student's legal parent/guardian. Please list student's information as accurately as possible.
Please complete one for each individual student. Thank you!
Permission of Transportation
My child has my permission to attend all activities associated with the Connection Point Church.*
If authorized, please list child's full name below.
I, (legal parent or guardian), give permission for the Pastoral Staff, ministry leaders, volunteers and other agents to provide transportation to and from youth programs/activities.*
Transportation will be via bus, foot, car (or other passenger vehicle), or train. If the parents/guardians are unavailable for emergency transportation, the parents/guardians give permission for the Pastoral Staff, ministry leaders, volunteers and other agents to drive our child to emergency care.
If authorized, please list full legal parent/guardian name below.
Authorization to Consent to Treatment of Minor
We (I) the undersigned parent(s) of a minor, so hereby authorize Connection Point Church as agent(s) for the undersigned to consent to any x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under license, under the provisions of the Medicine Practice Act on the medical staff of any Clinic of Hospital, whether such diagnosis or treatment is rendered at the office of the physician or at the hospital or clinic.
It is understood that this authorization is given in advance of any special diagnosis, treatment, or hospital care being required but is given to provide authority and power on the part of the aforesaid agent(s) to give specific consent to any physician in the exercise of his best judgment may deem advisable.
Consent to treatment of:*
If authorized, please list child's full name below.
Consent to treatment by:*
If authorized, please list full legal parent/guardian name below.
Approval of Parents/Guardian and Waiver of Claim
I hereby approve this application and certify to its correctness and expressly waive all claims against Connection Point Church, or any of its board or representatives because of any injury or other damage that may be incurred to the applicant named on this form or said applicant's property in connection with or incident at church authorized and sanctioned functions.
I, also herby grant Connection Point Students/Connection Point Church all right, title and interest in any and all photographic images and video or audio recordings made by Connection Point Students/Connection Point Church through the duration of this year. Including, but not limited to, any royalties, proceeds or other benefits derived from such photographs or recordings.
Parent/Guardian Signature*
Risk of Exposure to COVID-19 and Related Health Risks
Any interaction with others from the general public poses an inherent risk of exposure to COVID-19. People who show no symptoms can spread COVID-19 if they are infected. COVID-19 is an extremely contagious disease that can lead to severe illness and death. The CDC advises that older adults and people of any age who have underlying medical conditions are especially vulnerable to severe illness from COVID-19.
By sending your child to gatherings, retreats, or events, you acknowledge that you voluntarily assume all risks related to exposure to COVID-19.
Connection Point Students, or any Connection Point Students’ sponsored event, normally involves opportunities for close interaction with others. Your child will be free to pass or participate according to their own personal physical and emotional boundaries. Some aspects of Connection Point Students will be modified to offer increased social distancing where possible. We will also take additional measures to sanitize high touch points throughout our facilities. Nevertheless, we do not guarantee that your child will not be exposed to COVID-19.
By having your child attend Connection Point Students, or any Connection Point Students’ sponsored event, you voluntarily assume all risks related to exposure to COVID-19 and agree not to hold Connection Point Church, or any of their directors, officers, employees, agents, contractors, or volunteers liable for any illness or injury.
Parent/Guardian Signature*
Student's Medical Information
This form is to be filled out by the legal parent/guardian only. Please list student's information as accurately as possible.
i.e. hyperactivity, diabetic, sleep wetting, asthma, etc.
Please list any medical conditions pertaining to the student:
List all prescription and over-counter medications that child has with him/her (Include ear and eye drops, stomach and headache aids, inhaler, cough syrup, etc.)
If taking prescriptions or over the counter medications, what is the reason for taking?
List any food allergies the student has:
List any medical allergies the student has:
In case of emergency please notify:*
Please list name and phone # of 2 emergency contact persons other than student's parent (i.e. grandparent, uncle, neighbor, etc.)
Family Doctor and contact number:*
Please list student's primary care physician and contact number below
Parent/Guardian Signature*