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Children’s Ministries Calvary Church Children’s Ministry, 1051 Landis Valley Road/Lancaster, PA 17601, 717-560-2341

Field Trip Permission Form Activity for: Date of Activity: City/Location of Activity: Leaving Church Time: Person in Charge:

Place of Activity: Returning Time: Phone where person in charge can be reached:

Please complete the form below, cut it, and send it along with your child. Your child WILL NOT be able to attend without a completed permission form! Permission Form Participant’s Name:






Zip: Emergency Contact Person:

Emergency Contact Phone Number(s):

Allergies or Special Instructions: _____________________________________________________________________________________________ _______________________________________________________________________________ I give permission for my son/daughter to attend the above event. In the event of injury, I release Calvary Church from any claim. I give permission for my son/daughter to ride in any vehicle designated by the adult in charge. I give permission for the person in charge to seek medical services if needed. If you have HMO, please state requirements of that policy on back in order for person in charge to seek medical help. Parent Signature___________________________Date_________________________________________


Check Ministries area: Nursery Early Childhood Calvary Preschool Elementary Study and Share Kings Kids

Name of Child: __________________________________________________________________ Date of Report:

Time of Report: ________________________

Date of Accident:

Describe how and where the accident occurred: __________________________________

Describe any and all injuries to the child: __________________________________________

Was First Aid given? Yes _____ Explain what aid was given:


If yes, by whom?

Were the child’s parents notified of the accident? Yes _____ No _____ Date: Time: Whom did you speak with: Response from parent or guardian: Was the parent offered a copy of this form? Yes ____ No ____ Did the parent take a copy of this form? Yes ____ No _____

Other Comments: _______________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________

Incident handled by: ________________________________________________________ Signature of Ministry Director:__________________________________ Date ___________


Children’s Ministries Guidelines 

Incident Reports 

An Incident Report is an important means of communication between the worker and the director who may need to talk with the parent about the incident. In addition, it provides proper documentation to the insurance company in the event a claim is filed. • This form is to be filled out for any incident or injury which occurs during any Children’s

Ministries event, on or off-site, whether the injury appears serious or not. You do not need to fill out a report for simply giving a band aid. • The form should disclose only the name of the child for whom the incident is being

reported. If the incident involves two children, then two forms will have to be filled out, with the other child being referred to as “another child.” i.e.”Billy bumped his head with the head of another child while playing.” • The director should be informed promptly of any incident,

especially if it is a head injury.

• Teachers should inform parents of any minor incidents and a copy of the form should be

offered. The director will handle parent notification of any serious incidents or injuries. • All incident reports must be communicated to the director on the day it happens. • Incident reports can then be put in the director’s mailbox in the mailroom or handed to a

staff person at Children’s Ministries Central as soon as possible. • Incident Report Forms are found in the following locations:

—Nursery: kept in a file at the Nursery Welcome Desk —Early Childhood: kept in the each classroom’s attendance folder —Elementary: kept in the wall pocket by the door in each classroom —Calvary Preschool: kept in the teacher’s mailboxes in the Director’s office —Kings Kids: 5th and 6th graders’ forms are kept on the shelf outside of Cheryl Noel’s office. For all other ages/grades see Early Childhood and Elementary above locations.