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Grace Chapel Student Ministry


General Permission Waiver


LIABILITY RELEASE: In consideration of Grace Chapel allowing the Participant to participate in student ministry (Sunday morning, Midweek Activities, Events, Retreats, Trips) I, the undersigned, do hereby release, forever discharge and agree to hold harmless Grace Chapel, its Pastors, Board Members, directors, employees, volunteers and teachers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the student activities. I the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate fully in student ministry activities, including trips away from the church premises. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.

MEDICAL TREATMENT PERMISSION: In the event my child suffers an illness or injury that requires medical attention, I give Grace Chapel the authority to obtain whatever medical attention is deemed necessary, and release and hold harmless Grace Chapel its Pastors, Board Members, directors, employees, volunteers and teachers of any liability related to obtaining that medical attention. I understand Grace Chapel will make a reasonable attempt to contact me/us as soon as possible following the need for medical treatment for my child. In the event treatment is required from a physician and/or hospital personnel designated by Grace Chapel, I agree to release and hold the physician and/or hospital personnel harmless from any claims, demands, or suits for damages related to their acceptance of this document as consent to provide treatment. I also acknowledge I will ultimately be responsible for the cost of any medical care.

EARLY RETURN HOME POLICY: Should it be necessary for my child or youth to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility.

TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for my child/youth to ride in any vehicle driven by an approved and licensed ADULT chaperone while attending and participating in activities sponsored by Grace Chapel. My child and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during transportation.

Grace Chapel Student Ministry Rules & Guidelines

The following rules and guidelines are equally binding on adult leaders/chaperones and students/participants. 

Non-Negotiable Rules: Any participant failing to abide by these rules will be sent home immediately at personal/family expense.

  • No POSSESSION OR use of illicit drugs or alcohol
  • Presence at and full participation in all group activities, including adherence to curfews and other time-related instructions
  • No sexual misconduct (defined as exposure, touching, or inappropriate reference to body areas normally covered by undergarments)
  • Must be in assigned rooms by designated time
  • Abide by our policies regarding appropriate physical contact, as outlined in our Next Gen Safety Policy
  • Smoking and the POSSESION OR use of tobacco products are not allowed to, from, or during any events
  • No student is allowed to drive other students during trips or grace chapel events,, even if he/she possesses a valid Drivers License
  • No fighting, weapons, fireworks, lighters or explosives
  • Will not break any laws in the United States or any other country.

Community Guidelines

  • Participants will be respectful of community spaces & the property of others
  • Participants will avoid the use of foul language, cursing, or any speech (including “humor”) which puts down, makes fun of, or stereotypes other persons or groups.
  • If an overnight, sleeping areas will be sepatated by gender assigned at birth and visitation to the opposite sex sleeping areas is not allowed
  • No offensive clothing (degrading or inappropriate language/symbols)

I Agree

Student Participant’s Statement: By initialing this form, I pledge to respect others during this activity by following the rules and guidelines printed above. I understand that I cannot participate in the activity unless this completed form is on file.

Parent/Guardian’s Statement: By signing this form, I agree to support the rules and guidelines printed above, and will accept responsibility for the payment of my child’s return transportation should s/he break one of the non-negotiable rules.


Please select who will be participating...
Minor
Continue
Photo Release
I hereby give permission to Grace Chapel to use my child's photographic or video likeness in relevant forms and media for promotional materials and any other lawful purposes. *
Yes
No
First Participant's Name
First Name*
Last Name*
Phone*
Select Gender
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Campus *
Foxboro
Lexington
Watertown
Wilmington
Guest
First Participant's Signature*
Participant's 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:*
Emergency Contact

In case of emergencies, Student Ministry staff or volunteers will contact Parent/Guardian #1 first, then Parent/Guardian #2, then an alternative emergency contact.

Parent/Guardian #1 Name *
Parent/Guardian #1 Phone Number *
Parent/Guardian #1 Email *
Parent/Guardian #2 Name
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Email

Additional Emergency Contact (in case parent/guardians can't be reached). Please provide name, phone number, email address, and relationship to student *
Medical Information
Student's Primary Care Physician *
Primary Care Physician Phone Number *
Insurance Company *
Policy/Group ID# *
Policy holder's name *

Medical conditions: please answer in detail if applicable or write N/A 

List any medical conditions the participant has (asthma, diabetes, epilepsy, etc.)
List any allergies (only related to drug/medicine, food, and/or insects, etc.) and the severity and type of reaction:

Please explain any other pertinent information about the participant (i.e. physical, behavioral, mental health, or emotional) that would be important for adult leaders to know.
My child is prescribed emergency lifesaving medication (e.g. epi-pen, inhaler)*
No
Yes
My child requires prescription medication and I understand that I must fill out a separate waiver before every trip/event where medication is required to be distributed to my child. *
No
Yes
Do you give permission for your child/student to be given over-the-counter medication as needed and directed on the label, to treat non-emergency medical conditions that do not require a doctor or hospital visit such as a minor headache, stomachache, or allergic reaction while at a student ministry event.*
No
Yes
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Relationship*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Campus *
Foxboro
Lexington
Watertown
Wilmington
Guest
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.


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