Windsor Cornerstone Student Ministries

1200 Cornerstone Drive Windsor, Co 80550

Youth Group Permission Slip & Registration

2017-2018 School Year

I/We, ____________________________________________, as the legal guardian(s) of _______________________________________ do consent to his/her involvement in youth sponsored activities of Cornerstone Baptist Church 1200 Cornerstone Dr. Windsor, Co 80550.

I/We also give permission for my (our) youth to ride in any vehicle driven by an approved adult chaperone while attending and participating in activities sponsored by Cornerstone Baptist Church. My youth and I understand that seat belts (if available) shall be worn at all times during transportation.

I/We also give my (our) permission for the leadership of the youth program

to admit my (our) child to medical care facilities and give authorization for

my youth to be treated immediately if any injury or illness should occur

while participating in youth program related activities.

I/We do not hold Cornerstone Baptist Church, its youth program or any of its leadership, liable for any incident or accident that may occur while participating in the youth program.

I/We understand that in an effort to provide the best possible atmosphere at

church sponsored events, youth are expected to cooperate with all advisors

at all times. If my (our)son or daughter fails to adhere to guidelines, I/We authorize the persons in charge of the event to take such action as they deem necessary and appropriate, which may include immediate return home at the

Parent/Guardian’s expense.

I/ We agree that any photos or videos taken by the group can be used by the

youth group director in communications such as the church bulletin, the

church web site, newsletter and Facebook page. Nothing will be posted to

“You Tube” or “Facebook” without permission of those involved.

Parents Signature: ____________________________________________________________

Date: __________________________________________

Please complete the back page of this form. Thank you.

Students Name: ____________________________________________________________

Address: ____________________________________________________________________

Home Phone: __________________________________________

Parents/Legal Guardians Names: ___________________________________________

_____________________________________________________________________________

Cell Ph: ___________________________ add # to text updates?

*we send out occasional text updates for youth events and information

Home Ph: _______________________ Work Ph: ________________________

Students Email______________________________________________________________

Family Email________________________________________________________________

Emergency Contact________________________________________________________

Home Ph________________________ Cell Ph__________________________

Doctors Name: ___________________________________________________________

Phone Number: ___________________________________________

Insurance Company: ________________________________________________________

Policy#: ________________________________________________

Please list any allergies or medication your student takes:

Allergies: ___________________________________________________________________

_____________________________________________________________________________

________________________________________________________________________________

Medications:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Other Considerations/Comments:_____________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Unless a permission slip is specifically required for a specific event, this

Permission slip will cover all activities throughout the 2017-2018 year.