EmailMe Form - CPF Family Information

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!

____________________________

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. You may email a photo to Office@myCPF.org if you cannot attach one at this time. 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 - if you've more than five students, please fill out two forms. (Apologies for the inconvenience.)

First Child

Name *

First Last

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

Gender *

Birth date *

MM / DD / YYYY

Grade (2024-2025) *

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

Attach a current individual photo. If you cannot do this now, please email one to "office@mycpf.org" as soon as possible.

Second Child

Name

First Last

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

Gender

Birth date

MM / DD / YYYY

Grade (2024-2025)

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

Attach a current individual photo. If you cannot do this now, please email one to "office@mycpf.org" as soon as possible.

Third Child

Name

First Last

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

Gender

Birth date

MM / DD / YYYY

Grade (2024-2025)

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

Attach a current individual photo. If you cannot do this now, please email one to "office@mycpf.org" as soon as possible.

Fourth Child

Name

First Last

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

Gender

Birth date

MM / DD / YYYY

Grade (2024-2025)

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

Attach a current individual photo. If you cannot do this now, please email one to "office@mycpf.org" as soon as possible.

Fifth Child

Name

First Last

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

Gender

Birth date

MM / DD / YYYY

Grade (2024-2025)

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

Attach a current individual photo. If you cannot do this now, please email one to "office@mycpf.org" as soon as possible.

______________________________

CAREFULLY READ ALL THE INFORMATION BELOW before you submit this form. Some info IS redundant, as the state of Florida has particular wording they require us to attach to waivers and permission forms. You should still read it all. :)

Check appropriate boxes and be sure to sign this form!

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

Sunday Classes/Children's Church

Wednesday Night BLAST (Fall 2024-Spring 2025)

VBS 2024 -June 16-21, 6-8:30pm

Youth/Kids activities outside of Sundays and Wednesdays (Youth Fantastic Fridays, etc.)

I give CPF permission to text me regarding:
(check all that apply) *

Student activities

Vital CPF Notifications (cancelled acivites, etc.)

Info on other CPF Activites (short, few in number)

Do not text me

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 this way. If I do not wish to grant this 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