I give the participant listed on this form permission to go with Mount Vernon Baptist Church on their various student ministry events and outings. These events and outings range from concerts, camps, retreats, local non-recreational activities and mission projects. I realize that this is a general form to be placed on file in the student ministry office upon which the church may use when necessary. I also understand that for some student ministry events there will be an additional form to be used to notify of parental consent for various events.
Personal Property Waiver
I understand that it is my responsibility to safeguard any personal property I bring. I further understand that Mount Vernon Baptist Church will not under any circumstances be responsible for any property lost, misplaced, or stolen, either directly or indirectly. I further understand that such loss may or may not be covered under my insurance and that Mount Vernon does not have any insurance to cover any such loss of my own personal property.
I understand that as a participant, my child may be photographed or videotaped during normal activities and that these photographs or videos may be used in other materials.
As the parent/guardian of the participant, I certify that the information provided on this form is correct to the best of my knowledge. In order that appropriate diagnosis and treatment may be promptly carried out and so that no unnecessary delays will occur, I give permission for such diagnostic, therapeutic, and operative procedures as may be deemed necessary for the person named. No major operation will be performed, however, except in an emergency, without a parent or guardian being contacted and fully informed. I assume final responsibility for medical expenses incurred by the participant, and for expenses involved in returning the participant home for medical reasons, or for any of the following reasons substance abuse (drugs and alcohol), endangering the life of another person, sexual misconduct, or illegal misconduct. I understand that each individual is responsible for his/her own insurance coverage during any trip. I hereby release and forever discharge Mount Vernon Baptist Church, its staff, all sponsors, state conventions, employees, and any designated individual in charge of any trip from any legal responsibility, financial responsibility, all claims, demands, actions or cause of ac- tion, past, present, or future with respect to my personal or child’s participation in any church activity.
Code of Conduct Agreement
After reading the Code of Conduct I give the Student Ministry staff of Mount Vernon Baptist Church permission to enforce the Code of Conduct in agreement with the student ministry philosophy. I give the Student Ministry leadership permission to use their discretion, knowing that a team approach will be utilized to enforce rules and make final decisions as to the severity of the reprimand. If my child is seen by the Student Ministry leadership as having an infraction of these rules and regulations, I will support their decision of the reprimand and follow through with the understanding in Section 2 of the Code of Conduct document.
After reading the Code of Conduct I understand the seriousness of the Code of Conduct and will respect it and the adult leadership at all times. I will strive to obey these important regulations as they will provide for me a safe, good and healthy experience. If infractions of any of these guidelines are made, I will take responsibility and follow the above agreement in Section 2 of the Code of Conduct document.
I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The par- ticipant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.
Date submitted: June 8, 2023
Mount Vernon Baptist Church • 11220 Nuckols Road • Glen Allen, VA 23059 • (804) 270-6600 • mountvernon.church