Family Ministries: Care Plan
Parent/Guardian Address: *
Parent/Guardian Address:

Developmental Information

We desire to give every child an excellent experience. This care plan will help our team serve your child best. Complete all sections that apply.
Describe your child's communication (select all that apply)
My child uses an Epi-Pen
Please select any behavioral difficulties that apply to your child, and rate the frequency in which the behaviors occur: (1 = Occurs rarely; 5 = Occurs often)
We look forward to partnering with you to provide the best care for your child! A campus representative will connect with you soon!

Administration and use of Epi-Pen

By signing, I ( ) agree to waive and release any and all liability for CedarCreek Church in the administration and use of the Epi-Pen. I agree to forever release and discharge CedarCreek Church and its staff and volunteers from any and all liability, claims, actions, rights of actions, damages, and expenses, including attorney expenses, arising out of or resulting from any injury, disease, or death in the use, failure to use or the administration of the Epi-pen. If my child cannot administer the Epi-Pen themselves, I allow CedarCreek Church staff and volunteers to administer the Epi-Pen.