Loading...

High School Ministry 

RELEASE; PAYMENT OF EXPENSES; MEDICAL CONSENT

The undersigned parent(s) or legal guardian(s) (“Parent”) grants permission for their son or daughter (“Child”) to participate in Seattle Church of Christ’s weekly activities (“Activities”) from October 2024 through October 2025. Specifically, this waiver is for all weekly activities; this means Sunday morning activities, Wednesday evening or weekend activities that will take place at 2555 8th Ave W, Seattle, WA 98119, the immediate vicinity and any rental facility we rent. This includes, but is not limited to, events that may occur following church services as well as any outside events taken place in the homes of other High school parents.


Parent expressly understands that participation in indoor or outdoor strenuous or otherwise physical activities involves risks of property damage, injury or death that no amount of care, caution instruction or expertise can eliminate. Weather and conditions can shift and change without notice. As such, even diligent effort cannot account for outdoor activities such as those that will take place. These dangers include, but are not limited to, variations in terrain and surface conditions, falls, loss of control, collisions with other individuals or with natural and man-made objects. In other words, there are inherent risks associated with the Activities that Parent acknowledges and accepts, as noted above.


The Parent grants permission to SCOC and its employees and agents to seek and secure any medical attention or treatment for the minor including hospitalization, if in the agent’s opinion such need arises and SCOC is unable to contact the Parent. The Parent gives consent to any licensed physician to administer drugs or medicine or to perform such medical procedures as that physician determines necessary for the relief of pain and to preserve the minor’s life or health. Additionally, Parent hereby grants permission for SCOC or its agents to administer basic medical treatment in the event such need arises, including the administration of over-the-counter medications.


The Parent agrees to assume the responsibility for all medical, transportation, rescue and other related expenses incurred on behalf of the minor.




PLEASE READ CAREFULLY. THIS DOCUMENT CONTAINS A RELEASE AND WAIVER OF LIABILITY.

Please select who will be participating...
Minor
Continue

On occasion, SCOC takes photographs or makes an audio or video tape recording of middle schoolers involved in church activities. Such photographs or video records may be used by staff and participants to remember the activities or participants. In addition, such photographs and audio/visual recordings may be used in SCOC publications or advertising materials to let others know about SCOC’s ministry. The Parent consents to the use of any such audio or visual record of the minor named one this waiver to be used, distributed, or displayed as agents of the church see fit. This consent includes but is not limited to: photographs, videotape, and audio recordings. Likewise, SCOC livestreams services which may include ministry opportunities for high schoolers. As a result, the minor may be on SCOC’s livestream feed and other social and other streaming media.


Parent consents to the use of any such audio or visual record of the minor named on this waiver.*
Yes
No
My teen may participate in (check all activites or check the activities you do not want them participating).*
Check which one applies *
ALL Activities
ALL EXCEPT those marked below
Check which activities you want to EXCLUDE:
Corn maze
Halloween Party
Friendsgiving
Christmas Party
Pool Party
Bonfires
Paint war
Lake activities
Camping
Devotional activities
Fundraising activities
Sleepovers
Dancing
Movies
Hiking
Other sports and recreational activities
List allergies, special conditions or limitations, special medication, etc. None of the persons leading or directing these activities may accept responsibility for alerting a participant about required medication or administering such medication.
Minor's Relevant Medical Information
What Region does your High Schooler primarily attend?
East
West
Northshore
What grade is your High schooler currently in?
Click current grade. *
9th
10th
11th
12th
Other than the parent please provide an emergency contact for your minor.
Full name and Phone number *
The following information is requested in the event that the minor needs medical attention or treatment while participating in these activities.
Minor's Medical Insurance Carrier Information (Name and policy number) *
First Parent's Name
First Name*
Last Name*
First Parent's Age Acknowledgment*
First Parent's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Parent's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.

I acknowledge that I have read and understand this entire waiver of liability and release, and I agree to be legally bound by it.

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*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
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!