Note: An adult chaperone is NOT required to attend for child to participate. However, dads are welcome and encouraged to attend weekly Brigade meetings even if they are not filling a volunteer or leadership role.

Please list any health issues that may affect the activities, food consumption, well-being or medical treatment of your child(ren), e.g. conditions like asthma, a physical handicap, allergies, heart condition. Also indicate any medications your child(ren) may be taking.

Portage Community Chapel and its representatives may take and use photos, videos, or other imaging formats of children participating in PCC-affiliated ministries. Participation in these activities constitutes agreement for use of such images for website, facebook, advertising, and other related purposes.

Every activity sponsored by Portage Community Chapel is carefully planned and adequately supervised. However, even with the best of planning and precaution, unforeseen events can occur. By signing this form, I agree to assume and accept all risks and hazards inherent in church-related social activities, both at the church and other locations selected by the church. I also agree not to hold this church or its employees or volunteer assistants liable for damages, losses or injuries to the person or property of the participating clubbers listed above. Every attempt will be made to contact the parent or emergency contact I have listed on this form. However, if I/they cannot be located, I hereby give my permission to the physician or dentist selected by the church leadership to secure proper medical treatment for my child, as deemed necessary. I understand that my electronic signature below is both a medical and liability release.