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Consent For Treatment of a Minor and Activity Registration Form
  • For School Year 2020–2021


    This authorizes the administrator or other CCS staff to give consent for medical treatment, including emergency surgery, for the participant/student named below, in the event that neither parent/guardian is available at the time such consent for treatment is needed.
    This consent will be in effect while this student is enrolled at Central Christian School. 
     

  • Other important health information about your student (such as allergies, chronic illness, etc.)

  • Please give the names of two people who would know how to reach parent or legal guardian in the case of an emergency

  • Electronic Signature
    The electronic signature below is treated by Central Christian School like a physical handwritten signature on a paper form.

    Agreements
    My signature below affirms that all the information contained in this consent form is correct, complete, and honestly presented. 

  • Release of All Claims
    For Grades 6-12 Only

    In consideration for being accepted by Central Christian School for participation in all sporting events and associated activities whether or not sanctioned by the Kansas State High School Activities Association, including but not limited to club football, I do hereby release, forever discharge and agree to hold harmless Central Christian School and the directors, administrators, employees, and agents thereof from any and all damage and expenses, if any may be incurred by the undersigned's participant/student while participating in the activities indicated.  I hereby assume all risk of personal injury, sickness or death, damage and expense as the result of the participant/student's participation in sporting events or other activities, including transportation whether furnished by Central Christian School or not, associated with these events.

    Further, authorization and permission is hereby given to Central Christian School to furnish any necessary transportation, food and lodging for the undersigned's participant/student during scheduled trips for sporting events and related activities.

    On behalf of the participant/student I hereby grant permission to transport the participant/student to a doctor or hospital and authorize medical treatment, including but not limited to emergency surgery or medical treatment, and assume the responsibility of any and all medical bills.  Further, should it be necessary for the participant/student, to return home due to medical reasons or otherwise, I hereby assume all transportation costs.

    The undersigned further hereby agrees to hold harmless and indemnify Central Christian School, its directors, administrators, employees, and agents, for any liability sustained by said Central Christian School as the result of the negligent, willful or intentional acts of said participant/student including expenses incurred as a result thereof.

    This release of all claims shall be effective for the school year August 1, 2020 through July 31, 2021

    Participant/Student or Parent/Guardian Acknowledgment

    I (We) have read the above and agree to all the stipulations contained herein and hereby approve of this release and give our consent. We hereby give our consent for our student to compete in the activities listed below and to receive emergency medical treatment when necessary.  The undersigned agrees to be responsible for the care and prompt return of all equipment issued by the school to the student.  We also agree to maintain the standard of conduct as expressed by the school or coach to the student.  
     

  • Electronic Signature
    The electronic signature below is treated by Central Christian School like a physical handwritten signature on a paper form.

    Agreements
    My signature below affirms that all the information contained in this consent form is correct, complete, and honestly presented. 

  • CENTRAL CHRISTIAN SCHOOL ACTIVITIES



    Please check all the activities that the student intends to participate in.