Himpact Permission Slips

Off-Site Activity Permission & Liability Waiver Form Himpact Youth Ministry High School Students

Student Name *Enter your full name.

Date of Birth *

Grade *

Parent/Guardian Name *Enter your full name.

Phone Number *

E-Mail *

Event Information

Event Name : Courageous • Youth Summer Camp 2026

Date of Event : July 13 - 17, 2026

Location of Event : 1400 S Paradise Valley Rd, Prescott, Az 86303

Transportation Provided by AZ Limo

Departure Time : 7:30 AM

Return Time : 5:00 PM

Permission & Consent I, the undersigned, as the parent/legal guardian of the above-named student, give my permission for my child to participate in the off-site activity with Calvary Chapel Sierra Vista's HimPact Youth Ministry. I understand that this event may involve transportation to and from the activity site and participation in physical or recreational activities.

Medical Authorization In the event of an emergency where I cannot be reached, I authorize the adult leaders of Calvary Chapel’s Himpact Youth Ministry to seek and authorize emergency medical treatment, including transportation, diagnosis, hospitalization, hospitalization, and other medical procedures and other medical procedures deemed necessary by qualified medical personnel.

Allergies or Medical Conditions

Allergies Please list all allergies

Medications Please list medications

Medical Conditions Please list medical condition

Insurance Provider & Policy #

Emergency Contact *Enter your full name.

Emergency Phone Number *

Emergency E-Mail *

Release of Liability I acknowledge that participation in this event involves a certain degree of risk. I hereby release and hold harmless Calvary Chapel Sierra Vista’s Himpact Youth Ministry, its leaders, volunteers, staff, agents, and affiliated organizations, including the sponsoring church, from any and all liability, claims, demands, or causes of action that may arise from personal injury, sickness, death, or property damage that may occur during or as a result of my child's participation in this event, including transportation to and from the event.

This release applies whether arising from negligence or otherwise, to the fullest extent permitted by law.

I further agree to indemnify and hold harmless the released parties from any claim brought by or on behalf of my child as a result of their participation in this event.

Behavior Agreement I understand that my child is expected to follow the rules and instructions given by Calvary Chapel Sierra Vista's HimPact Youth Ministry Leaders and volunteers. Failure to comply may result in my child being sent home at my expense.

Parent/Guardian Digital Confirmation By clicking the SUBMIT button below, I confirm that I have read, understood, and agree to all of the above.

Himpact Permission Slips

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