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Student Medical Waiver/Liability Form

ALL STUDENTS ARE REQUIRED TO FILL OUT A MEDICAL WAIVER FORM TO ATTEND ANY TRIP WITH CAMPBELLSVILLE BAPTIST CHURCH.

MM slash DD slash YYYY
STUDENT INFO
Address
MM slash DD slash YYYY

PARENT/GUARDIAN INFO
Address

EMERGENCY CONTACT INFO

FAMILY PHYSICIAN INFO

MEDICAL HISTORY

CHECK ALL THAT APPLY
CONSENT FOR TREATMENT

Links

  • Home
    • About Us
      • Service Times & Location
    • Staff
    • Contact
    • What to Expect
    • What We Believe
  • Ministries
  • Christian Life Center
    • CLC RESERVATION FORM
    • Accident Release & Liability Form
  • Calendar
  • Giving
  • Watch Live
    • Watch Live!
    • Past Sermons & Worship Services
  • Online Forms
    • Connect With Us!
    • YAH Derby Dinner
    • YAH Kentucky Dinner Train
    • Deacon Ministry
    • Highlight Ministry
    • Student Medical Waiver Form
    • Facility/Vehicle Request Form: CBC Sponsored Event
    • Church Matching Scholarship Application
    • Background Authorization Form
    • Prayer Needs

Connect With Us

270-465-8115

campbellsvillebaptistchurch@gmail.com

420 North Central Avenue
Campbellsville Kentucky 42718

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