HEALTH RECORD, CONSENT FOR TREATMENT, AND RELEASE
Note: Parent/Guardian - It is important that you complete the following Health Record. Copies of this paperwork will be maintained in the Church office and taken on in-town, overnight and out of town trips.
EXPECTING THAT THE LEADERS FOR ANY EVENT/TRIP WILL EXERCISE REASONABLE CARE IN OVERSEEING THE ACTIVITIES OF THE STUDENTS, I REQUEST AND AUTHORIZE THE LEADERS TO SEEK WHATEVER MEDICAL CARE IS NECESSARY AND ADVISABLE SHOULD AN EMERGENCY ARISE WHICH WOULD REQUIRE TREATMENT FOR MY SON/DAUGHTER.
In order that my son/daughter may receive the proper medical treatment in the event that he/she may sustain injury or illness during a church activity, I hereby authorize the leaders to obtain or provide medical treatment for my son/daughter for such injury or illness during the activity, and I hereby hold harmless First Baptist Church of Fairhope, Alabama Inc. and the leaders, in the exercise of this authority.
I further understand that there is always a possibility that my son/daughter may sustain physical illness or injury while participating in an event. If this occurs, I hereby authorize First Baptist Church of Fairhhope, Alabama Inc. and the leaders to refer my son/daughter for medical treatment, including a medical treatment center (hospital, etc.). I further acknowledge and understand that I will be responsible for any medical bills that may be incurred on behalf of my son/daughter for physical illness or injury that he/she may sustain during the event/trip.
Understanding that there is always a possibility that my son /daughter may sustain physical illness or injury, I acknowledge and understand that my son/daughter is assuming the risk of such physical illness or injury by his/her participation, and I further release and hold harmless First Baptist Church of Fairhope, Alabama Inc. and the leaders from liability for any and all claims for personal illness or injury that my son/daughter may sustain during the event/trip named above.
I understand that, in the event my child requires medical or dental treatment while engaged in the activity, reasonable efforts will be made to contact me; however, if I cannot be reached, I hereby consent and give permission to the ministry’s sponsor or any adult counselor acting on behalf of the ministry with respect to the Activity, as agent for me to consent to any X-ray examination; injections; anesthesia; medical, dental or surgical diagnosis and treatment; and the services are rendered, either as an outpatient or in any hospital. To the best of my knowledge, I have listed above all of my child’s medical allergies, medications being taken, medical problems and other pertinent information.
Annual Liability Release Form
Release of All Claims - Minor Participants
In consideration of being accepted by First Baptist Church of Fairhope, Alabama Inc. for participation in all church activities, events or trips to be held during the next year, we (I), being 19 years of age or older and parent or legal guardian of minor listed below for ourselves and on (Student/Child’s name) behalf of the child-participant do hereby release, forever discharge and agree to hold harmless First Baptist Church of Fairhope, Alabama Inc., its staff, employees, leaders, directors, volunteers and any other agents (hereinafter called “agents”) from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and/or the child-participant that occur while said child is participating in any church activity, event or trip, irregardless of the location(s) of such activity, event or trip.
Assumption of Risk
Furthermore, we (I) assume all risk of personal injury, sickness, death, damage and expense as a result of participation in all aspects of the above referenced activity/event for ourselves and on behalf of the child participant. Such risks may include exposure to other participants who are ill or have special medical conditions.
The undersigned agrees to hold harmless and indemnify First Baptist Church of Fairhope, Alabama Inc. and its agents for any liability and related expenses sustained by said Church as the result of the negligent, willful or intentional acts of said participant.
Medical Treatment Authorization
Permission is granted to take said participant to a doctor of hospital if needed. We (I) authorize medical treatment, including but not limited to emergency surgery, and assume the responsibility of all medical bills, if any.
Unplanned Transportation Costs
Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) assume all transportation costs and as appropriate, to fully indemnify and / or reimburse First Baptist Church of Fairhope, Alabama Inc. or its agents.
Further, we (I) consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of the child-participant during their participation in any activity, event or trip to be used, distributed, or shown as said Church sees fi t including but not exclusive to: slide shows, church website, print media and local newspapers.
Parental Permission Release Form
I (we), the parent(s) of (student/child’s name), hereby give permission for my student to attend and/or participate in events and trips with First Baptist Church of Fairhope during the year of TBD. I understand that travel will be provided by Church bus/van unless otherwise notified.
We understand that First Baptist Church of Fairhope, Alabama Inc.does not represent that swimming will be supervised by professional or certified lifeguards. In consideration of (Student/child’s name) being allowed to go on any said (Student/child’s name) trip during the year of TBD, we release First Baptist Church of Fairhope, Alabama Inc., it’s staff, chaperones, and members from any claim or cause of action for injury, sickness, damage or loss of whatsoever nature sustained on said trip, and we agree to protect, indemnify, and hold harmless First Baptist Church of Fairhope, Alabama Inc. its staff, chaperones, and members and to pay them all sums which they may be subject to pay in consequence of any claim by, or injury, sickness or death to (Student/Child’s name).
We also give permission for any hospital, physician or medical personnel to administer treatment as needed to (Student/Child’s name) in case of illness or injury.
Today's date: October 2, 2023