Release of Liability Form (2026)

Your name *

Email address *

Child's Full Name *

Child's Grade *

min: 0 / max: 12

By checking this box, I certify that my child (named above) has my permission to participate in any functions, activities, or events of the Children’s or Youth Ministry of Morningstar Christian Chapel, on-site or off-site, for the calendar year of 2026. *

Acknowledgement of Release of Liability *

By checking this box, I certify that as the parent or legal guardian of the child named above, I hereby release, forever discharge, and hold harmless Morningstar Christian Chapel and all of their officers, employees, volunteers, and agents acting officially or otherwise, from any and all medical, injury, or other liability claims, as well as property damage and expenses.

I give my child permission to ride as a passenger with the following adults (check all that apply).

Other Parents

Any Licensed Youth Leader

In Case of Emergency Information

I hereby give my permission and authorize medical treatment for my child if I cannot be contacted. *

Child's Date of Birth *

Child's Street Address *

Include City, State, Zip

Father's Name

First/Last

Father's Cell Phone Number

Father's Email Address

Mother's Name

First/Last

Mother's Cell Phone Number

Mother's Email Address

Medical Insurance Carrier

Medical Insurance Carrier Phone Number

Policy Holder's Name

Policy Number

Insurance Group Number (if applicable)

Allergies or Special Medications

Emergency Contacts

Emergency Contact #1 Name *

First/Last

Emergency Contact #1 Relation to Child *

Emergency Contact #1 Phone Number *

Emergency Contact #2 Name *

Emergency Contact #2 Relation to Child *

Emergency Contact #2 Phone Number *

Digital Signature *

By typing my name I submit my digital signature.

Digital Signature Date