Family Information Form

North Point Community Church reserves the right to request photographic identification for any or all persons who may attempt to pick-up a child from North Point Community Church, and to refuse to release the child in accordance with either this authorization form, lawful and enforceable court orders, state or federal laws or, in North Point Community Church’s sole discretion, for the health and safety of the child.
Parent Contact Information
 
 
 
 
 
 
Child Information
 
 
 
 
 
 
 
Authorized Person(s)
Child may be released from/by North Point Community Church to the following person(s). Please list anyone whom we can release your child to including names and relationship to the child.
 
 
 
 
 
Unauthorized Person(s)
Child may not be released from/by North Point Community Church to the following person(s). We recognize that there are unfortunate circumstances where an individual cannot have a child released to their care. Please list anyone whom we cannot release your child to including names and relationship to the child.
 
 
 
Signature of Parent(s) or Guardian(s)
By typing your legal name below you are certifying that you are the legal parent or guardian legally authorized to grant or deny permission. In addition, you are certifying that all of the above information is true to best of your knowledge. 

Also, you agree that 

"I, on behalf of myself, my spouse, child’s parent(s), and any and all heirs, assigns, agents, personal representatives, insurers, and any other individuals or entities who could act on my behalf or interests, hereby release and forever discharge North Point Community Church, its officers, directors, agents, employees, assigns, representatives, insurers, volunteers, and any other affiliated individuals or entities, from any and all claims, demands, actions and causes of actions and all liability, whatsoever, whether or not negligently caused, in any manner arising out of North Point Community Church’s release of above named child in accordance with this authorization form."
 
 
 

Description

North Point Community Church reserves the right to request photographic identification for any or all persons who may attempt to pick-up a child from North Point Community Church, and to refuse to release the child in accordance with either this authorization form, lawful and enforceable court orders, state or federal laws or, in North Point Community Church’s sole discretion, for the health and safety of the child.