• Christian Church of Clarendon Hills

    Medical Waiver & Paintball Event Waiver

    This medical waiver is applicable for the 365 days that follow the participant’s date of signing.


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  • I already have a Medical Waiver on file with CCCH from within the last year. *
  • Date of Birth*
     - -
  • Format: (000) 000-0000.

  • Medical Information

  • Please check any medication participant CANNOT take

  • Does the participant have allergies?*
  • Does the participant currently take any medication?*
  • Does the participant have any limitations or health conditions?*

  • Insurance Information

  • Do you have medical insurance?*
  • Upload a File
    Cancelof
  • Format: (000) 000-0000.

  • Emergency Contact Information

    Names of emergency contact person(s) in case you cannot be reached.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • IN CASE OF EMERGENCY, I hereby authorize an adult leader from or staff member of the Christian Church of Clarendon Hills, as an agent for me, to consent to any X-ray examination; medical, dental, or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state or country where the services are rendered, either at a doctor’s office or in any hospital.  

  • Signature of participant (guardian must sign if participant is under 18 years of age)*
  • Image field 41

  • Paintball Release Form (CCCH)

  • Would you be willing to let others carpool with you to the event?

  • By signing below, I, the participant in this event (or parent/guardian, if under 18 years of age) understand that:

    • Our group will travel in either rented vans or vehicles of participating individuals to Legacy Paintball in Lockport, IL on Saturday, September 12 for four hours of paintball activities.
    • We will rent equipment from Legacy Paintball; no one will bring their own paint, air, or equipment.
    • I am responsible for my own actions as well as safety during this event.
    • There will be food provided at this event and I must communicate any allergic concerns or other food issues before the event.
    • My conduct is meant to be respectful toward others at all times and that I will be sent home early if I cannot conduct myself as such.
    • I accept all risks and dangers associated with this event as well as responsibility for any costs that may be incured due to illness, injury, or unforeseen circumstances. 

    ALSO, I will complete Legacy Paintball's medical waiver before this event begins (CLICK HERE). 

  • Signature of participant (guardian must sign if participant is under 18 years of age)*
  • Should be Empty: