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North Metro First Baptist Church

LIABILITY RELEASE FORM

Release of All Claims

In consideration for being accepted by North Metro First Baptist Church for participation in All Student Events and Activities from January 1, 2025 through December 31, 2025 we (I), being 21 years of age or older, do for our selves (myself) (and for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless North Metro First Baptist Church and the directors thereof from any and all liability, claims or demands for personal injury, sickness and death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above described trip or activity.

Furthermore, we (I) (and on behalf of our (my) child-participant if under the age of 21 years) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein.

Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this participant.

The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees and agents, 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.

(If the participant has not attained the age of 21 years):

We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in said trip, and thereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs.


Parent/Legal Guardian or Participant (if 21 years of age or older)

If parents are separated or divorced, the custodial parent must sign. 

Today's date: July 16, 2025


PARENTAL CONSENT FORM

To whom it may concern:

The undersigned does hereby give permission for our (my) child, to attend and participate in activities sponsored by North Metro First Baptist Church from January 1, 2025 through December 31, 2025.

We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff or a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.

Should it be necessary for our (my) child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs.

The undersigned does also hereby give permission for our (my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by North Metro First Baptist Church.

Parent/Legal Guardian or Participant (if 21 years of age or older)

If parents are separated or divorced, the custodial parent must sign. 


Today's date: July 16, 2025

Please select who will be participating...
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First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Grade In or Just Completed *
School *
Address (Please include City, State & Zip Code) *
Parent/Guardian Name(s) *
Parent/Guardian Cell Phone #(s) *
Parent/Guardian Email(s) *

Please list any allergies or medical concerns we should be aware of - if none, please type NA *
Emergency Contact Name (in the event that parent/guardian cannot be reached) *
Emergency Contact Phone # *
First Participant's Signature*
Insurance
Insurance Carrier*
Insurance Policy Number*
Insurance Card
Front of Insurance Card *
  
Valid file types: JPG, GIF, PNG, and PDF
Member Services Phone # (See back of insurance card) *
Provider Services Phone # (See back of insurance card) *
Parent or Guardian's Email Address
Email*
Confirm Email*





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*
Middle Name
Last Name*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Grade In or Just Completed *
School *
Address (Please include City, State & Zip Code) *
Parent/Guardian Name(s) *
Parent/Guardian Cell Phone #(s) *
Parent/Guardian Email(s) *

Please list any allergies or medical concerns we should be aware of - if none, please type NA *
Emergency Contact Name (in the event that parent/guardian cannot be reached) *
Emergency Contact Phone # *
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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