Student Medical and Travel Release Form 2023/2024
The following health record must be filled out for each student by the parent or legal guardian. The student may not be a part of any College Church extracurricular activity until we have a completed form on file. A new form must be filled out at the beginning of each school year. If you have any questions, please contact a College Church ministry staff member.
Treatment: In case of emergency, I hereby give permission to the physician selected by the College Church staff and/or assigned personnel to hospitalize, secure treatment for, and to order injection, anesthesia, and/or surgery for the student named above.
Punctuality: I agree that my student should be punctual for designated departure times. If my student is more than 15 minutes late for an announced departure, I understand that College Church may leave for the event without my student. I agree that it is my responsibility to ensure that my student is picked up at the designated time at the church. I understand that College Church reserves the right to exclude my student from future events if I am continually late in either dropping off or picking up my student.
Dated: February 29, 2024
I hereby grant to The College Church of the Nazarene, Inc. (CCN), a Kansas corporation, and those acting pursuant to CCN’s authority, the right to use my photograph(s), without my name in conjunction with its exhibition, on its website or in other official church publications, printed, online, or otherwise, without further consideration.
I acknowledge the church has the right to crop or treat the photograph(s) at its discretion.
I also acknowledge that the church may choose not to use my photograph(s) at this time, but may do so at its own discretion at a later date.
I also understand that once my image is posted on the church’s website, the image can be downloaded by any computer user, anywhere in the world.
Therefore, I agree to indemnify and hold harmless the church, its pastor, associate pastors, its church board members and designees from any claims arising out of the use of my photograph(s).
The church reserves the right to discontinue use of any photograph(s) without notice.
If a dispute over this agreement or any claim for damages arises, I agree to resolve the matter through a mutually acceptable alternative dispute resolution process. If I cannot agree with Church upon such a process, the dispute will be submitted to a three-member arbitration panel of the American Arbitration Association for final resolution.
By signing this document, I understand that:
The photographs will only be used for not-for-profit purposes
The photographs cannot be edited or changed in any way without the consent of CCN
The photographs become the property of CCN
I waive the right to inspect or approve the finished product, including written or electronic copy, where my likeness appears
My name will not be published in conjunction with my likeness.
RENUMERATION: It is understood between both parties that there will be no renumeration.