This information is confidential. At no time will your child's name, contact information, social security number and/or insurance information be given to anyone except in the case of an emergency, and then, only to the proper admittance personal at said facility. This consent will remain in effect until 11:59.59 pm on the 31st day of December 2024, unless revoked earlier in writing. This form must be filled out, in full, in order for your child to participate in any Crossway Compass Kids activity.
If you have multiple students who share the same medical insurance, the policy information only needs to be added to one of the students forms. Please indicate below:
In the event that my child should need emergency medical attention, Crossway Church and/or any one of its agents or employees is hereby authorized to provide such emergency medical care, including without limitation; medical, dental, surgical care or hospitalization, to my student as recommended or suggested by a physician, nurse, surgeon, or other healthcare professional. I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I cannot be reached in an emergency during the activity dates shown on this form, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment, or order an injection, anesthesia, or surgery for my child as deemed necessary. If such emergency care is provided, I understand that my child’s health insurance and healthcare information will be provided to the healthcare professional and healthcare institution providing care for my child. I further understand that any expense not covered by my child’s medical insurance shall be my responsibility. I understand that Crossway Church, will not be obligated to pay either the healthcare professional or me for any medical expenses incurred on behalf of my child.
I understand that my child may be included in video highlights and/or photographs during the course of the year and that said pictures and videos may be used for promotion of Crossway Church events and/or posted on Crossway Church website and/or other social media pages.
I give authority and permission to Crossway Church, staff and its agents to inspect my child’s belongings while on activities, retreats or camps for the safety of my child, other children, staff and agents of Crossway Church and all other participants. If inappropriate/illegal/illicit materials are found in my child’s possession, I understand proper levels of disciplinary action will be taken as decided by the group leader. Should it be necessary for my child to return home due to medical reasons, disciplinary action, or otherwise, I assume all transportation costs.
