EmailMe Form - Children and Youth Information

This information is for the checked activities: (Check all that apply) *

Sunday Classes/Children's Church

Wednesday Night BLAST

VBS 2022 - June 27-July1, 6:00PM

We ask our families to update information each school year. Thank you for your help in keeping our information current!

We've allowed for up to five children on this form. Send us a second form if your family is larger. Thank you!

PHOTOS

If possible, please attach a family photo and an individual photo of each child where noted. If you cannot do this now, please email these photos as soon as possible to office@mycpf.org. Thank you!

FAMILY INFORMATION

You'll enter personal information on each child following this section.

Your Name
(Parent/Guardian
registering children) *

First Last

Your Best Contact Phone *

### - ### - ####

Your Best Email contact *

Your Spouse (if applicable)

First Last

Spouse's Best Phone

### - ### - ####

Spouse's Best Email contact

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

If you have a PO Box, please put it in "Address Line 2"

Family Photo

It is VERY helpful to have a current family photo on hand. It helps our leaders match kids to parents. THANK YOU!

OTHER ADULTS

If anyone OTHER than adults named above may pick up your children, please include that information here:

List names of adults who may pick up your children. If you'd like that person to be an emergency contact and they aren't a CPF attender, include a phone number.

STUDENT INFORMATION

First Child

Name *

First Last

Nickname? Include in parentheses after First Name [Susan (Sue) ]

Gender *

Birth date *

MM / DD / YYYY

Grade (2022-2023) *

If this child has special needs, including allergies, etc., please tell us here.

Attach a current individual photo. If not available immediately, you may email one to "office@mycpf.org."

Second Child

Name

First Last

Nickname? Include in parentheses after First Name [Susan (Sue) ]

Gender

Birth date

MM / DD / YYYY

Grade (2022-2023)

If this child has special needs, including allergies, etc., please tell us here.

Attach a current individual photo. If not available immediately, you may email one to "office@mycpf.org."

Third Child

Name

First Last

Nickname? Include in parentheses after First Name [Susan (Sue) ]

Gender

Birth date

MM / DD / YYYY

Grade (2022-2023)

If this child has special needs, including allergies, etc., please tell us here.

Attach a current individual photo. If not available immediately, you may email one to "office@mycpf.org."

Fourth Child

Name

First Last

Nickname? Include in parentheses after First Name [Susan (Sue) ]

Gender

Birth date

MM / DD / YYYY

Grade (2022-2023)

If this child has special needs, including allergies, etc., please tell us here.

Attach a current individual photo. If not available immediately, you may email one to "office@mycpf.org."

Fifth Child

Name

First Last

Nickname? Include in parentheses after First Name [Susan (Sue) ]

Gender

Birth date

MM / DD / YYYY

Grade (2022-2023)

If this child has special needs, including allergies, etc., please tell us here.

Attach a current individual photo. If not available immediately, you may email one to "office@mycpf.org."

AS A PARENT/GUARDIAN OF THE MINORS listed above, for myself, my spouse and other family members,

1. I understand that my child/children will participate in physical activities and, as with any physical activity, there is a risk of injury. I fully accept and hold harmless from any legal liability, CrossPointe Fellowship and any persons involved in the CrossPointe Children’s or Student Ministries. I release any and all rights and claims for damages my child/children may have against CrossPointe Fellowship, its volunteers and staff for any and all injuries or death suffered while on CPF property or an authorized outing. This includes all medical and legal bills.

2. I give my permission for CrossPointe staff and volunteers to administer needed first aid to my child/children . In the event of an emergency that requires medical treatment, I understand that the church will try to contact me and, if I cannot be reached, I authorize CrossPointe staff and volunteers to use emergency medical services (911) as necessary for my child's well being. I also agree to assume all costs connected to any accident or treatment of my child/children.

3. I understand that my child/children may be photographed and videoed during events sponsored by CPF and that these photographs and videos may be used on the church's website, social media websites, in church publications, and in local newspapers. I grant permission for these photographs and videos to be used in these venues. If I do not wish to grant permission, I will notify the church in writing within 3 days of registering my child/children for a CrossPointe program.

4. In the event that transportation is required during a program for an outing, I understand that parents, volunteers, and church staff may be driving their own vehicles. I understand that all reasonable safety measures will be taken when transporting my child/children and I will not hold the drivers or church liable for any motor vehicle incidents, and do hereby release the drivers, CrossPointe Fellowship and its volunteers and staff from any and all actions, claims and demands for, upon or by reason of any damage, loss or injury, which may be sustained by my child/children.

THANK YOU for allowing us the privilege of having your children in our activities. Please call the office (941.778.0719) if there are special circumstances you need to discuss.

By submitting this form, you acknowledge that all information is correct and that you agree to the above statements.

Submitted by *

Relationship to Children: *

If "other", please explain:

VBS NOTE

Please be aware that VBS is in the EVENING this year (6:00-8:15) and that we will be grouping according by 2022-2023 grades. If you have any concerns/questions, please contact Steve or Tanya DeWitt. The church office can supply contact info.