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IMPACT Youth Group

A safe place for teens where they are challenged to make positive choices

Open to middle/high school students

We meet one Saturday a month for our IMPACT time plus get together for special events.

For future events, check out our event calendar!

 

Calvary Chapel Student Medical Release & Waiver of Liability

Waivers are needed for each student participating in any Impact Ministries event and/or outing. This waiver covers Impact meetings, events, & travel UNTIL 12/31/2018. THIS FORM DOES NOT COVER MISSION TRIPS OR ANY SPECIAL FORMS NEEDED BY ANY EVENT FACILITIES.

Student's Name *
Student's Name
Date of Birth *
Date of Birth
Parent/Guardian's Name *
Parent/Guardian's Name
Primary Emergency Contact
Primary Contacts Cell Phone *
Primary Contacts Cell Phone
Primary Contacts Home Phone
Primary Contacts Home Phone
Secondary Emergency Contact Name *
Secondary Emergency Contact Name
Secondary Contacts Cell Phone *
Secondary Contacts Cell Phone
Physician's Name *
Physician's Name
Physician's Phone *
Physician's Phone
Please Check All That Apply