NOTE: This includes any prescription or non-prescription medication, herbal supplements, and vitamins. Any participant under the age of 18 is required to give ALL MEDICATIONS to the adult youth leader in their original containers with complete dispensing instructions before the start of the event. Youth are not permitted to carry any prescription or non-prescription medication and will be sent home at the parent/guardians' expense if they do.

All data is encrypted and transmitted securely.

I certify that I am the parent/legal guardian of the participant. I allow and give permission for my minor to attend Calvary Youth's Fall Retreat on November 14-16, 2025 at Camp Spofford in Spofford, NH with Lynnfield Calvary Christian Church, Inc.
--
*By checking this box I am stating that I am over the age of 18 and am one of the official guardians of the participant listed in the "Parent Guardian Section". I understand that if I am not the undersigned guardian that I am making myself and the undersigned liable for the agreement made, and the transmittal of the information thereof, and am responsible for falsifying this agreement.

In consideration for being allowed to participate in the aforementioned trip and other valuable considerations the receipt of which is acknowledged, I hereby give consent for my child/minor to participate in any activities, events, or programs associated with the trip/event and understand that these activities may include, but are not limited to:

1. Riding on the church provided vehicle(s) to and from fall retreat

2. Participating in: recreation room activities, basketball, soccer, flag football, arts & crafts, coffee shop, rock climbing, dodgeball, hiking & more

3. Attending a bonfire with s’mores

4. Being both photographed and video recorded for updates to be featured on Calvary Youth's social media accounts or promotional material for youth ministry for next year’s event
--
*By checking this box I am stating that I am over the age of 18 and am one of the official guardians of the participant listed in the "Parent Guardian Section". I understand that if I am not the undersigned guardian that I am making myself and the undersigned liable for the agreement made, and the transmittal of the information thereof, and am responsible for falsifying this agreement.

I, the parent/guardian of minor, certify that the minor is physically able to participate in the trips activities listed above unless I have noted they should not participate (e.g., if the event involves boating or swimming, I certify that the child is able to swim, etc.). I also certify that I have listed below any allergies and/or medical conditions that may be relevant to a physician in the event of an emergency. (Please put “none” if your child does not have any medical allergies or conditions the church or a physician may need to be made aware of). In the event of an emergency, I do understand that every effort will be made to contact me, but in the case that I cannot be reached I herby give authorization for Lynnfield Calvary Christian Church, Inc. and its representatives permission to authorize treatment and make emergency decisions for my minor. I understand that Lynnfield Calvary Christian Church, Inc. will take reasonable precaution and care to insure the minor’s safety.
--
*By checking this box I am stating that I am over the age of 18 and am one of the official guardians of the participant listed in the "Parent Guardian Section". I understand that if I am not the undersigned guardian that I am making myself and the undersigned liable for the agreement made, and the transmittal of the information thereof, and am responsible for falsifying this agreement.

I, the parent/legal guardian of the minor, acknowledge that I am aware of where the minor is traveling and voluntarily accept the risks associated with such travel and activities, including but not limited to injury and even death. I knowingly and freely assume all such risks, both known and unknown, and however arising, even if arising from the negligence of other participants, volunteers, or employees of Lynnfield Calvary Christian Church, Inc. I will assume full responsibility of the above listed participant. I agree to assume liability for all medical costs, attorney’s fees and any and all other expenses and damages resulting from injury to myself and/or the participant(s) listed above associated with this trip/event. I, for myself and on behalf of my spouse (if any), children, relatives, representatives, heirs, estate, next of kin, assigns and others hereby release and hold harmless Lynnfield Calvary Christian Church, Inc. and its employees, volunteers, representatives, church leadership and officers and all other participants with respect to any and all expenses, medical bills, causes of action, claims, injury, disability, loss and damage to person or property to the fullest extent permitted by law. I agree to hold Lynnfield Calvary Christian Church, Inc. and all its officers, agents, volunteer staff and employees free from liability and negligence in the event the minor stated above suffers personal property injury or personal injury. I understand, however, acts of gross negligence by the staff/volunteers of Lynnfield Calvary Christian Church, Inc. are not precluded from the church’s liability.
--
I agree to inform the church immediately of any change in any of the information presented and agreed to here, and understand that this form is valid until revoked by me in writing.
--
*By checking this box I am stating that I am over the age of 18 and am one of the official guardians of the participant listed in the "Parent Guardian Section". I understand that if I am not the undersigned guardian that I am making myself and the undersigned liable for the agreement made, and the transmittal of the information thereof, and am responsible for falsifying this agreement.

By typing my full legal name below I am stating that I am one of the parents/guardians listed in the "Parent/Guardian" information above and am the legal guardian of the Participant listed on this form.