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IMPORTANT: THIS DOCUMENT CONTAINS A RELEASE OF LIABILITY. YOU ARE ADVISED TO REVIEW IT CAREFULLY. PLEASE PRINT AND PROVIDE ALL INFORMATION REQUESTED. 

Consent to Participate: 

I hereby give permission for Participant to attend and participate in Sierra Bible Church's Youth Group activities. 

Release of Liability: 

Prior to Participant's participation in SBC Youth Group activities, I acknowledge that involvement of Participant in these activities involve risk of property damage and personal injury, illness or even death of Participant, including but not limited to the risks arising from transportation-related activities, recreational activities, accident related to facilities, adverse weather conditions, and other injuries and/or illness. In addition, I understand that there may be other risks inherent in SBC Youth Group of which I may not be presently aware. By signing this Parental Consent and Release of Liability, I warrant that Participant is fully capable of safely participating in all activities, and I expressly assume all risks of Participant's involvement whether such risks are known or unknown to me at this time. I further generally release Sierra Bible Church and their directors, employees, volunteers, and other participants at the activity from any and all claims that I or Participant make, as a result of involvement in SBC Youth Group activities, whether on or off activity grounds. I agree that this release includes the ordinary, special and inherent risks described above, and other risks that I may not foresee or be aware of at this time. This Release of Liability is given on behalf of myself, participant, and the heirs, family, estate, administrators, executors, personal representatives and assigns of me and Participant. 

Consent to Medical Treatment: 

If Participant experiences an injury or illness, or has other medical needs, I authorize Sierra Bible Church, SBC Youth Group, and it's employees, volunteers, and agents to make such arrangements for Participant's health and safety, including but not limited to first aid, emergency medical care, ambulance or other transportation to a hospital, medical office, or clinic, testing and examination, and hospital care, and other medical care and treatment (including dental care) as they feel are appropriate in the circumstances. I further agree that I am fully responsible to pay all charges and expenses relating to such care, transportation and treatment, and I hereby fully release Sierra Bible Church, SBC Youth Group, and its directors, employees, and other participants from any claims, including claims for medical charges, prescription costs and other expenses, I might have as a result of such are, transportation and treatment. My signature below also serves to indicate my willingness for my Health Insurance Company (please provide details in the Medical Information section) to be billed for any and all medical fees and services should they be needed. I agree that I will pay all charges and expenses not covered by insurance. 

Other Releases and Acknowledgement: 

I understand that, while Participant is involved in SBC Youth Group, photographs, film, audio recordings and videotape of Participant may be taken and may be used in brochures, videos, releases to the press, and various church publications and other work product. I do hereby irrevocably grant Sierra Bible Church and SBC Youth Group permission to record, display and/or reproduce my child's name (first name only), likeness and voice on audio and/or video tape, film or other media, to edit and otherwise modify such media at its discretion, to incorporate the media or by any means, methods or technologies now known or hereafter to be known. 

I understand that Sierra Bible Church and SBC Youth Group does not provide transportation to and from activities and do hereby take responsibility for either providing or arranging for transportation of Participant, and for ensuring that Participant will arrive and depart by the scheduled dates and times. 

I will ensure Participant only wears/brings clothing that adheres to the Activity Dress Code or similar policy. If Participant fails to abide by established rules, standards of conduct, activity staff or volunteers reserve the right to send Participant home or exclude Participant from the activity. If it becomes necessary to send Participant home, I hereby agree to provide transportation or make travel arrangements for Participant and to assume the cost of these expenses. 

To the extent any provision of this document is found to be unenforceable, such provision shall be deemed servable and shall not affect the enforceability of any other portion of this document and shall be reformed to be in compliance with the law and construed to most nearly reflect the intent of the parties. 

I give my permission for Participant's bags or belonging to be searched and seized by SBC staff. I represent and warrant that I am a parent or legal guardian of the Participant named above and have the full power and authority to enter into this Parental Consent and Release of Liability on behalf of the Participant. By signing below, I acknowledge that this document has been read and understood by me and also represent that all information provided is accurate.


Guardian is required to sign below. 

Date: February 26, 2026

First Participant's Name
First Name*
Last Name*
Phone*
Select Gender
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Second Participant's Signature*
Third Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Third Participant's Signature*
Fourth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Fourth Participant's Signature*
Fifth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Fifth Participant's Signature*
Sixth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Sixth Participant's Signature*
Seventh Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Seventh Participant's Signature*
Eighth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Eighth Participant's Signature*
Ninth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Ninth Participant's Signature*
Tenth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Tenth Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
Medical Information:
Medical Insurance Co.
Policy Number

(Please attach a copy, front and back, of your insurance card) 

Click Choose File to upload Insurance Card *
  
Valid file types: JPG, GIF, PNG, and PDF
Address:
Phone:
Insured's Name:
Doctor's Name:
Phone:

List any medical/ food allergies, or other behavior problems or physical conditions of Participant (please write "None" if applicable):
I give my permission for Participant to take Tylenol, Advil, Midol, Motrin, Aspirin, Cold Medications, Benadryl, or similar allergy medication, at the discretion of the directors, employees, volunteers, and other participants of the activity. *
No
Yes
Date of last Tetanus Shot:
Will Participant be under any medication while participating with SBC Youth Group activities?*
No
Yes
If yes, please provide details
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 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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