PLEASE RETURN! THIS FORM IS GOOD FOR ALL January 01, 2023 to December 31, 2023 TRIPS!
All participants in any outing or event with First Baptist Church of Sylacauga (FBCS) must have a current signed waiver/release form on file. This includes all participants under 19 years of age, adults, and children of adult leaders.
Church: First Baptist Church, 10 S. Broadway, Sylacauga, AL 35150; 256-245-6301, www.joinfirst.net
Consideration: I acknowledge the personal benefits accruing to my child (and me) by reason of participation in the above described outing/event and am aware of the activities my child (or I) will be participating in. Activities may include (but are not limited to) mission trips (in-state, out-of-state, foreign), camps, retreats, conferences, sightseeing, shopping, amusement parks, etc.
WAIVER AND INDEMNITY AGREEMENT
CHURCH SPONSORED OR HOSTED EVENTS
PERMISSION CLAUSE: By my signature below, I agree if I or my child (hereafter referred to as the participant), becomes ill or sustains injury while on an outing with FBCS or while attending an event hosted by FBCS, a staff member or representative of FBCS has my permission to administer first aid and/or take the participant to the nearest medical facility for additional treatment. I also agree to hold harmless FBCS, any of FBCS's ministers, staff, chaperones, and/or volunteers personally or financially responsible for any accident or illness which may occur during an event or outing.
PHOTO RELEASE AGREEMENT: I further understand photographs or video recordings may be created during these events (including Sunday and Wednesday activities), and I give permission for FBCS to use any or all recordings of the participant in publications, videos, website design, or other media expressions (including social media). I waive all rights to control any aspect of these photographs and recordings.
DISCIPLINARY AGREEMENT: In the event it become necessary to send my child home for disciplinary reasons, by my signature below, I agree to assume responsibility for any cost incurred.
Medical Consent/Media Release Form
MEDICAL INSURANCE AGREEMENT: I hereby confirm the participant is covered and will remain covered under a medical insurance policy. If this coverage changes, I will promptly notify FBCS at 256.245.6301. I further agree that my insurance company will be the primary source of coverage in case of injury or illness held at or sponsored by FBCS involving my child, and I am responsible for any deductible expenses in connection with that coverage. By my signature below I agree to assume responsibility for medical bills, telephone calls, and other expenses relating to an emergency.
By my signature below, I, hereby, for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against FBCS and its agents, employees, representatives, successors, and assigns for any and all injuries suffered by myself or my child arising out of the below named Activity (program, outing, event, and/or sport) sponsored or hosted by FBCS.
I, as well, warrant I have the right to authorize the foregoing and do hereby agree to hold FBCS harmless of and from any and all liability of whatever nature which may arise out of or result from such participation. By signing this agreement, I hereby attest to and represent that I am legally permitted to enter into this agreement on my own behalf or on behalf of the child named as a participant.
For the consideration stated above, I further agree in the event the participant should make any claim against FBCS for damages arising out of church-sponsored or church-hosted program, outing, event, and/or sport, I will personally indemnify, defend, and hold harmless FBCS and its agents, employees, representatives, successors, and assigns against any and all loss and damage occasioned thereby, including attorney’s fees.
I have read and understand this agreement and have willingly placed my signature below as evidence of my acceptance of all the conditions contained herein.
Today's date: February 6, 2023