Youth Photo/General Release Form

Please fill out one form per youth for the 2015-16 program year.


The undersigned parent or legal guardian of the child named below, a minor child, does hereby grant permission for said child to engage in the various activities sponsored by Christ Church Grosse Pointe for its Youth Program including, but not limited to, travel in automobiles, attendance at related group activities on or outside of church property, such as Laser Quest, the ropes course at Wayne State and general participation in any and all activities sponsored by or associated with Christ Church Grosse Pointe.

The undersigned parent or legal guardian also grants permission for the said child’s pictures to be taken at Youth Group and/or Christ Church Grosse Pointe sponsored events on or outside of church property, which can be used on the church website (www.christchurchgp.org), social media accounts, Flickr page, and promotional materials.

This consent also includes specific permission hereby granted to the adult supervisors and leaders of Christ Church’s Youth Program to make medical decisions with respect to the said minor child in the event of accident or injury when parental consent shall be unavailable or when circumstances shall require immediate medical decision, and to administer medication when required.


MEDICAL INSURANCE INFORMATION

(ie, disabilities, allergies, current medications, pre-existing conditions, etc.)