EmailMe Form - CPF Children & Youth Information

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

Sunday Classes/Children's Church

Wednesday Night BLAST

VBS 2023 - June 19-22, evening

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!

We have tried to include all the info for VBS in this form too, although we may ask for updated pictures at that time.

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 parents named above may pick up your children, please include that information here:

List names of other adults who may pick up your children. If you'd like that person to be an emergency contact please 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."

Paragraph Text

PERMISSIONS AND WAIVERS

This section is important. The final section is required by the State of Florida.

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

1. I understand that my child/children/ward(s) [hereinafter called “child” whether singular or plural] will participate in physical activities while attending events at or sponsored by CROSSPOINTE FELLOWSHIP (also referred to as CPF,) and, as with any physical activity, there is a risk of injury or death. I understand that these activities may include, but are not limited to, playing on playground equipment, participating in a variety of sports (basketball, volleyball, football, pickleball, street hockey, etc.), creating various crafts, going on fishing excursions, tubing, “nerf wars”, racing rocket cars, walking to the Gulf, and a variety of classroom activities that may include tossing balls or using foam “noodles.” I understand I have the right and obligation to notify CROSSPOINTE FELLOWSHIP in writing (you may email office@mycpf.org) within one week of registering my child if I do not wish my child to participate in a specific activity and will contact a leader if I have questions regarding an activity.

Despite all known and unknow risks, I fully agree to hold harmless from any legal liability, CROSSPOINTE FELLOWSHIP and any persons involved in the ministries of CROSSPOINTE FELLOWSHIP. I release any and all rights and claims for damages my child 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 of CROSSPOINTE FELLOWSHIP ministries. This includes any and all medical and legal bills.

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

3. I understand that anyone participating in CROSSPOINTE FELLOWSHIP activities, including myself, my spouse, my child, and other family members, may be photographed, videoed, and/or recorded during events sponsored by CPF and that these media records may be used for purposes including, but not limited to, posting on websites and social media and including in printed materials, including newspapers. .I grant permission for these photographs, videos and other media to be used in this manner. If I do not wish to grant permission, I will notify CROSSPOINTE FELLOWSHIP in writing within one week of registering my child for CPF activities.

Required by the State of Florida:

NOTICE TO THE MINOR CHILD'S NATURAL GUARDIAN

READ THIS FORM COMPLETELY AND CAREFULLY.

YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN POTENTIALLY DANGEROUS ACTIVITIES.

YOU ARE AGREEING THAT, EVEN IF CROSSPOINTE FELLOWSHIP USES REASONABLE CARE IN PROVIDING THESE ACTIVITIES, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THESE ACTIVITIES BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITIES WHICH CANNOT BE AVOIDED OR ELIMINATED.

BY SIGNING THIS FORM, YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM CROSSPOINTE FELLOWSHIP IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITIES. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND CROSSPOINTE FELLOWSHIP HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

Submitted by *

Relationship to 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.

Signature

Clear

Date

MM / DD / YYYY