Crossroads Student Ministry: Student Info/Code of Conduct

Crossroads Community Church
Student Information and Code of Behavior


Rules of Behavior Expected of Each Student
No Alcohol or Drugs permitted
Treat other Students and Leaders with respect
Respect the facilities and employees of the locations we visit
Students are to stay with at least one other student/leader at all times.

Parent and Student Release Statement

I/We understand that student activities may take place off campus and give permission for my child to travel with an adult leader from Crossroads Community Church. I/We have reviewed the rules of the trip and agree that the subject of this release will abide by them. I/We also acknowledge that if the subject of the release has to return home early for discipline violation; it will be made at my/our expense. I understand that in the event of medical intervention is needed; every attempt will be made to contact me/us or the emergency contact if I cannot be reached. In the event I cannot be reach in an emergency, I hereby give permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia or surgery for my child as deemed necessary.
I/we understand that all reasonable safety precautions will be taken at all times by Crossroads Community Church and it agents during the day’s events. I/we understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/We agree not to hold Crossroads Community Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases or injuries incurred by the subject of this form.


Student Name?
Your answer
Male or Female?
Parent or Guardian Name
Your answer
Home Address
Your answer
Emergency Contact Info
Your answer
Family Health Insurance
Your answer
Subscribers Name
Your answer
Policy Number
Your answer
Allergies/existing medical conditions/medications
Your answer
Have you as a Parent or Guardian read the Parent and Student release Statement and agree?
Has the Student read the Parent and Student Release Statement and agree?
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