TCC Student Waiver and Release Form
In the event of serious accident or illness, I request The Crossing Church or its representative to contact me
or my spouse. If we cannot be reached, the church or its representative may make whatever arrangements
are necessary to provide emergency care and treatment for my child. This may include transport to and
treatment at a licensed hospital, other licensed medical facility or licensed physician. We also give
permission to the physician selected by The Crossing Church or its representative to hospitalize, secure
proper treatment for, and to order injections, anesthesia, or surgery for our child as named herein. We, the
parents or guardians, will assume all responsibility, financial and otherwise, for services rendered.

In the case of an accident or illness where immediate treatment of our child is not indicated, but where he
or she is unable to remain at the event, we request that the church or its representative contact us to arrange
transportation for our child. If the church or its representative is unable to contact either of us, we request
that the emergency contact person(s) be contacted and requested to care for our child.

I acknowledge that The Crossing Church or any of its representatives is not liable for medical decisions,
medical expenses, hospital expenses, or other such charges incurred for such services as may be rendered
for or on behalf of our child as a result of injury or sickness. I understand that every precaution will be
taken to assure the safety of my child. If my child is injured or becomes sick, I will not hold The Crossing
Church or its representative responsible.

It is understood that this authorization is given in advance of any specific diagnosis or emergency treatment
being rendered.

Parent / Authorized Guardian Name *
Your answer
Parent / Authorized Guardian Phone Number *
Your answer
Parent / Authorized Guardian Email *
Your answer
Backup Emergency Contact Name *
Your answer
Backup Emergency Contact Phone Number *
Your answer
Student Name(s) *
Your answer
The Crossing Church, or its representatives, is authorized to transport my child to/from church functions/trips *
Required
Do you authorize The Crossing Church, or its representatives, to use photographs or videos of youth ministry events, which may include images of my child, in print or online (e.g., website, social media) materials designed for news or informational purposes related to The Crossing Church.The Crossing Church will not utilize your child’s name without prior consent. *
Required
I authorize The Crossing Church, or its designated representative, to contact my child directly via text, phone, or social media *
Required
Clicking the box below will serve as my digital signature authorizing the above as the parent or guardian of the children listed above *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of The Crossing Ministries. Report Abuse - Terms of Service