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Children's 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 and Wednesday evening 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, such as those following Easter (e.g. an Easter egg hunt) or Halloween (e.g. “Trunk or Treat”).


 

The Parent agrees and understands that participation includes possible injury and exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19, and while particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist, on behalf of my Child and family, Parent knowingly and freely assumes all such risks, both known and unknown, except as it arises from the gross negligence and intentional acts of SCOC and further agree to: 

(a) Refrain from participation in any and all activities if the following signs or symptoms are present:

  1. Fever and behavior changes that accompany fever (fever is anything over 100 degrees);
  2. Vomiting or diarrhea within the 24 hours preceding the service or activity;
  3. Rashes or raised bumps, excluding eczema.
  4. Pink Eye Infection/Redness - Defined as pink or red conjunctiva with or without a white or yellow discharge
  5. Symptoms and signs of severe illness, including:
  6. Coughing, sore throat, croup (except in the case of allergies)
  7. Runny nose that is not clear (Teething babies have clear runny noses)
  8. Sluggishness that is more than fatigue
  9. Difficulty breathing
  10. Lice, including the presence of eggs or nits.
  11. Parent further agrees that any SCOC team member, in SCOC’s sole and absolute discretion, may request that the Child be excluded or otherwise separated from any event, activity or service so as to protect other children from potential illness.

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 Child 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 Child’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. 


Parent understands and agrees that in order to maintain a safe and secure environment, strict adherence to the designated pick-up person for the Child is required. This means that the Parent agrees to provide SCOC with two authorized individuals who may pick up the Child from SCOC and any associated events or services. Likewise, the Parent agrees to provide with a list of any individual(s) who may not pick up the child and shall provide any supporting documentation, such as a court-ordered Parenting Plan. Should any of the aforementioned information change, Parent agrees to provide SCOC with reasonable notice regarding the same and shall update all information immediately with SCOC


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




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

Please select who will be participating...
Minor
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On occasion, SCOC takes photographs or makes an audio or video tape recording of children 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 Child named above 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 children and youth. As a result, the Child 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 Child named on this waiver.*
Yes
No
The Parent expressly warrants that the Child is capable of withstanding the physical, emotional and mental demands of the activities involved at the Activities, including rigorous physical activities, such as, but not limited to, outdoor sports and other physically and emotionally demanding activities, such as field games. The Parent expressly warrants that the child is capable of activities that are physically and emotionally demanding, such as, but not limited to, activities involving running, jumping and physical contact.*
Yes
No - If no, a youth ministry coordinator or region leader will contact you to discuss.
Parent understands and agrees that the Child is capable of using and playing on any of the so-called “playground” equipment, swings, and any similar equipment utilized by SCOC. Parent hereby releases and agrees to hold harmless, defend and indemnify SCOC, its directors, officers, employees and agents from and against any and all claims for personal injury (including loss of life) and all other losses or damages (except those caused entirely by the gross negligence or intentional conduct of SCOC) that the Child or the Parent may suffer as a result of the Child’s participation and/or enrollment in the Activities. *
Yes
No - If no, a youth ministry coordinator or region leader will contact you to discuss.
We offer snacks or treats at times. Does your child have any Allergies?
Yes
No
If yes, please list any allergies your child has
What Region does your child primarily attend?
Check one *
East
West
Northshore
Release of Child: Please designate which adults are allowed to pick up your child. No child in the children’s ministry shall be released from the classroom setting to any person other than a parent or the person who registered the child unless 1) a parent has previously indicated that a designated person can withdraw the child from the class as indicated hereinabove, or 2) exigent circumstances require release to an individual who is not authorized for pick up but is a reasonable designee under the circumstances. A person designated by the parent in writing for authorized release must be 16 years or older. It is up to the parent or legal guardian to inform YM workers if there is a legal basis for a child not to be released to the other parent.
Authorized adult(s)
Other than the parent please provide an emergency contact for your child.
Full name and Phone 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.


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