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SCC Student Ministry Waiver Form March 2026-March 2027
This form is our annual waiver form that must be filled out for every student participating in any of our student ministry events (summer camps, Strongholds, etc.). This form is good for one year and will be refilled out and updated if needed, every March. No matter when you join our student ministry, you will need to have one of these forms completed and submitted prior to participating in any of our big events. 

If a student is 18 years old they may fill out this form for themselves. If not, this must be filled out by a parent/guardian for each student that they have who participates in our student ministry. 

Now the fun stuff... 

I hereby give my permission for myself or my child to participate in an activity organized by Sycamore Creek Church. I hereby release, hold harmless and absolve Sycamore Creek Church, their staff, sponsors, vendors and all others who have participated in the planning, organizing, and implementing of the activity, be they individuals or organizations, singly or collectively, from responsibility and liability for any illness, injury, misadventure, harm, loss or inconvenience suffered or sustained as a result of the participation in the activity. I understand that in the event I or my child requires medical treatment while engaged in the activity, reasonable efforts will be made to contact my designated emergency contacts; however, if they cannot be reached, I hereby consent and give my permission to the Sycamore Creek Church staff or any adult counselor acting on behalf of Sycamore Creek Church with respect to the activity, to consent to any X-ray examination, medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either as an outpatient or in any hospital. To the best of my knowledge, I have listed below all my child’s medical allergies, medications being taken, medical problems and other pertinent information. Finally, I agree that Sycamore Creek Church may video photograph my child and record his or her voice during their participation in the activity. I agree that Sycamore Creek Church will be able to use them, in whole or in part, whether in original or modified form in any manner or media, including without limitation, for the purpose of advertising, promoting, and publicizing Sycamore Creek Church, whether during the activity or thereafter. I hereby release and discharge Sycamore Creek Church and all affiliated entities from any and all claims, demands, or causes of action that I have in connection with the use and exercise of the rights granted in this release.

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Student's Name  *
Student's gender, date of birth, age, grade, and phone number
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Student's Address (Street, city, state, zip) 
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Parent/Guardian Name
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Parent/Guardian Email address
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Emergency Contact #2 (please include name, phone number, and relation to the student) 
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Insurance carrier (if none, please put NA)
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Policy number 
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Name on insurance card
Physician's name, phone, and name of practice 
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Please list ANY allergies (food or medicine)
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Parent/Guardian full name
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Today's Date
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