Loading...

I hereby, for myself, my heirs, executors, and administrators, waive and forever discharge any all right and claims for damages which I may have or which may hereafter accrue to me against Team Church, their members, respective officers, agents, representatives, successors, and/or assigns, individually or collectively for any and all damages and liabilities which may be sustained and suffered by me in connection with my association with or arising out of my traveling with, participation in and returning from any activity or event sponsored by Team Church. The minors and others whose names and signatures are attached to this document do hereby consent to any and all medical and surgical treatments including anesthesia and operations, which may be deemed advisable by his or her physician and surgeons. I (we) understand that in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give permission to the staff or sponsor to secure the services of a licensed physician to provide the necessary care for my child’s well being. In witness of our consent and agreement to the matters stated in the preceding sentences, we have subscribed our signature to this document.

Dated: May 26, 2022

First Participants Name

First Name*

Last Name*
First Participants Date of Birth*
First Participants Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

First Participants Signature*
Second Participants Name

First Name*

Last Name*
Second Participants Date of Birth*
Second Participants Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

Third Participants Name

First Name*

Last Name*
Third Participants Date of Birth*
Third Participants Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

Fourth Participants Name

First Name*

Last Name*
Fourth Participants Date of Birth*
Fourth Participants Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

Fifth Participants Name

First Name*

Last Name*
Fifth Participants Date of Birth*
Fifth Participants Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

Sixth Participants Name

First Name*

Last Name*
Sixth Participants Date of Birth*
Sixth Participants Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

Seventh Participants Name

First Name*

Last Name*
Seventh Participants Date of Birth*
Seventh Participants Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

Eighth Participants Name

First Name*

Last Name*
Eighth Participants Date of Birth*
Eighth Participants Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

Ninth Participants Name

First Name*

Last Name*
Ninth Participants Date of Birth*
Ninth Participants Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

Tenth Participants Name

First Name*

Last Name*
Tenth Participants Date of Birth*
Tenth Participants Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

Participants Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Insurance

Insurance Carrier*

Insurance Policy Number*
Mom's Contact Info:

Mom Cell *

Mom's Email - (if not listed above)
Dad's Contact Info:

Dad Cell *

Dad Email - (if not listed above)
Church
Are you a Team Church member?*
No
Yes

If no, are you a member of a church? If so, where?
Emergency Contact

In the event a parent or guardian cannot be reached, please contact:


Emergency Contact Name: *

Emergency Contact Cell Phone: *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

One Family Form - All Activities: This waiver will be used for all your minor students and children for all Team Church ministry events and our Team Church Sports Ministry. Waiver is for one year starting September 1 and running through current school year plus summer events ending August 31.


Child's Grade: (In the current Sept 1 thru Aug 31 window) *
T-Shirt:*
YS
YM
YL
AS
AM
AL
XL
2X
3X

Please list any allergies or medical concerns:
Is this for your child to participate in Team Church Sports?*
No
Yes

Medicine Questions pertain to Camp and Overnight events.

Medicine Permission - I give permission for the Camp Nurse or Pastor to administer the below checked stock medications, if my child requests. (check all that apply)
Tylenol
Ibuprofen
Antacid
Benadryl
Does your child take any prescription medications that will need to be administered at a camp, retreat or overnight event? (child will not be allowed to self administer)*
No
Yes

If yes, you will be contacted by Camp Nurse or Pastor prior to camp or event to fill out medicine information form.

Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!