Team Church Waiver 23-24

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.

I waive and forever discharge any and all right and claims while my minor student(s) participate in a Team Church small group or off-site activity. I also acknowledge and understand that small group leaders may engage in mentoring and meeting with my minor student(s) and these events or activities are outside of regularly scheduled church activities and governance.

In addition to the above, I understand that photos and videos of church events, camps and services will be taken and possibly used for advertising on various media platforms.

Dated: April 26, 2024

Please select who will be participating...

Adult Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

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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 elementary and above children and students for all Team Church ministry events. Waiver is for one year starting September 1, 2023 and running through current school year plus summer events ending August 31, 2024. (Include all your children now, so you don't have to fill it out again later this year)

Child's Grade: In the current Sept 1 (2023) thru Aug 31 (2024) window*

T-Shirt Size:*

Child's allergies?*

List any allergies that are not covered above.

Does your child have any DRUG allergies?*

Yes

Please list any DRUG allergies your child has.

*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)*

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 elementary and above children and students for all Team Church ministry events. Waiver is for one year starting September 1, 2023 and running through current school year plus summer events ending August 31, 2024. (Include all your children now, so you don't have to fill it out again later this year)

Child's Grade: In the current Sept 1 (2023) thru Aug 31 (2024) window*

T-Shirt Size:*

Child's allergies?*

List any allergies that are not covered above.

Does your child have any DRUG allergies?*

Yes

Please list any DRUG allergies your child has.

*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)*

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 elementary and above children and students for all Team Church ministry events. Waiver is for one year starting September 1, 2023 and running through current school year plus summer events ending August 31, 2024. (Include all your children now, so you don't have to fill it out again later this year)

Child's Grade: In the current Sept 1 (2023) thru Aug 31 (2024) window*

T-Shirt Size:*

Child's allergies?*

List any allergies that are not covered above.

Does your child have any DRUG allergies?*

Yes

Please list any DRUG allergies your child has.

*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)*

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 elementary and above children and students for all Team Church ministry events. Waiver is for one year starting September 1, 2023 and running through current school year plus summer events ending August 31, 2024. (Include all your children now, so you don't have to fill it out again later this year)

Child's Grade: In the current Sept 1 (2023) thru Aug 31 (2024) window*

T-Shirt Size:*

Child's allergies?*

List any allergies that are not covered above.

Does your child have any DRUG allergies?*

Yes

Please list any DRUG allergies your child has.

*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)*

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 elementary and above children and students for all Team Church ministry events. Waiver is for one year starting September 1, 2023 and running through current school year plus summer events ending August 31, 2024. (Include all your children now, so you don't have to fill it out again later this year)

Child's Grade: In the current Sept 1 (2023) thru Aug 31 (2024) window*

T-Shirt Size:*

Child's allergies?*

List any allergies that are not covered above.

Does your child have any DRUG allergies?*

Yes

Please list any DRUG allergies your child has.

*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)*

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 elementary and above children and students for all Team Church ministry events. Waiver is for one year starting September 1, 2023 and running through current school year plus summer events ending August 31, 2024. (Include all your children now, so you don't have to fill it out again later this year)

Child's Grade: In the current Sept 1 (2023) thru Aug 31 (2024) window*

T-Shirt Size:*

Child's allergies?*

List any allergies that are not covered above.

Does your child have any DRUG allergies?*

Yes

Please list any DRUG allergies your child has.

*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)*

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 elementary and above children and students for all Team Church ministry events. Waiver is for one year starting September 1, 2023 and running through current school year plus summer events ending August 31, 2024. (Include all your children now, so you don't have to fill it out again later this year)

Child's Grade: In the current Sept 1 (2023) thru Aug 31 (2024) window*

T-Shirt Size:*

Child's allergies?*

List any allergies that are not covered above.

Does your child have any DRUG allergies?*

Yes

Please list any DRUG allergies your child has.

*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)*

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 elementary and above children and students for all Team Church ministry events. Waiver is for one year starting September 1, 2023 and running through current school year plus summer events ending August 31, 2024. (Include all your children now, so you don't have to fill it out again later this year)

Child's Grade: In the current Sept 1 (2023) thru Aug 31 (2024) window*

T-Shirt Size:*

Child's allergies?*

List any allergies that are not covered above.

Does your child have any DRUG allergies?*

Yes

Please list any DRUG allergies your child has.

*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)*

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 elementary and above children and students for all Team Church ministry events. Waiver is for one year starting September 1, 2023 and running through current school year plus summer events ending August 31, 2024. (Include all your children now, so you don't have to fill it out again later this year)

Child's Grade: In the current Sept 1 (2023) thru Aug 31 (2024) window*

T-Shirt Size:*

Child's allergies?*

List any allergies that are not covered above.

Does your child have any DRUG allergies?*

Yes

Please list any DRUG allergies your child has.

*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)*

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:*

Church

Are you a Team Church member?*

Yes

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

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)

Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

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.

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