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Bethel Church & Ministries, Inc.

Rise Up 2027 Authorization, Consent, and Release

Bethel Church & Ministries, Inc. (the “Church”) is organizing or planning certain Annual Events or activities generally described as the “Annual Events.” I wish for myself/my child to participate in the Annual Events.

  1. I/My Child may participate in the Event.
  2. I certify and affirm that I have been completely and thoroughly informed that, as a youth attending the Church, I/my Child will participate in certain activities which may carry with them a degree of risk and danger. Examples of risky and dangerous activities and hazards, both foreseeable and unforeseeable, include, but are not limited to: outdoor and indoor physical activities; sports and games, both informal and organized; use of recreational equipment; snacks given; activities with water; accidents or collisions; and inclement weather. These risks and hazards may result in serious physical injury, sickness, or death, and damage to, loss, or destruction of property, and no guarantee can be made that the Church or others can provide assistance if any of the foregoing result.
  3. If I/my Child is injured or needs medical attention while participating in the Event, I give the Church, its employees and volunteers, permission to seek medical diagnosis and treatment which in their best judgment they deem to be necessary or appropriate under the circumstances.
  4. In cases of emergency, I further consent to the examination or treatment of myself/my Child by a physician duly licensed to practice medicine or any health care professional duly licensed to provide health care services in the State of Indiana for medical care and services deemed necessary by the Church, its agents, volunteers, and employees.
  5. I give permission to the doctor or health care professional to provide any and all medical care they deem, in their professional opinion, to be necessary.  
  6. I agree to pay for any and all medical expenses incurred as a result of the use of this consent.
  7. I also agree to fully release and hold harmless the Church, its pastors, employees, agents, borrowed servants, contractors, and other workers, paid or volunteer, or their heirs and assigns, from any and all injuries, claims, liabilities or causes of action which may arise from the transportation or participation of myself/my Child in the Event.
  8. I acknowledge and understand that the Church may offer other activities not listed above that present similar risks or dangers to myself/my Child.
  9. I consent to my participation in these activities. I acknowledge and understand that this PARENTAL AUTHORIZATION, CONSENT, AND RELEASE has the same force and effect regardless of whether the activities engaged in are free or if a fee is charged.
  10. Further, I personally assume, on my/my Child's behalf, all risk in connection with said activities for any harm, injury or damages that may befall me/my Child as a result of my/my Child's participation in the activities, whether foreseen or unforeseen, and I still wish to allow myself/my Child to proceed with the activities.
  11. In consideration of me/my Child being allowed to participate in these activities and to use Church equipment, on behalf of myself/my Child, I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless the Church from any and all claims, demands, or causes of action, which are in any way connected with me/my Child’s participation in these activities or use of the Church’s equipment, whether owned or offered for use by various Church members and/or volunteers.
  12. I understand that it is my obligation to inform the management of the Church of any and all health considerations or medical conditions that would restrict my/my Child's participation in the Event.
  13. I acknowledge that I am not aware of any condition or limitation that would dictate not having me/my child participate in the Event. I will not allow myself/my Child to participate in the Event should I become aware of any such condition or limitation and will not allow myself/my Child to participate in the Event should s/he have any illness or disease which I reasonably understand to be contagious to others or would put others in jeopardy of contracting such illness or disease. 
  14. Should the need for medical attention arise, the Church will attempt to contact me as soon as practicable under the circumstances.
  15. By agreeing to this AUTHORIZATION, CONSENT, AND RELEASE agreement, I acknowledge that if anyone is hurt or property is damaged during my/my Child’s participation in these activities, I may be found by a court of law to have waived my right to maintain a lawsuit against the Church on the basis of any claim from which I have released them herein.
  16. I agree that if any portion of this AUTHORIZATION, CONSENT, AND RELEASE agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
  17. I consent to the use of my/my Child’s photograph, likeness, image, voice or performance on the Church’s website, social media, advertisements, or other official Church publications at the sole discretion of the Church and to be used in whole or in part of any and all broadcasting, audio/visual, and/or exhibition purposes in any manner or media.
  18. I have fully informed myself of the contents of this AUTHORIZATION, CONSENT, AND RELEASE by reading it before I agreed to it.
  19. I agree that any and all claims or disputes arising from or related to this AUTHORIZATION, CONSENT, AND RELEASE agreement, other than a claim for injunctive relief, shall first be submitted to mediation in Lake County, Indiana with a panel of one (1) mediator, and if not resolved by mediation, then by binding arbitration in Lake County, Indiana, with a panel of one (1) arbitrator under, and in accordance with, the then governing rules of The Institute for Christian Conciliation. In the event that the Institute for Christian Conciliation ceases to exist during the course of this AUTHORIZATION, CONSENT, AND RELEASE agreement, arbitration under this Section 19 shall be conducted according to the rules of the American Arbitration Association. Judgment upon an arbitration award may be entered in the District Court for the County of Lake, Indiana. The Church and I shall bear our own costs related to any mediation or arbitration proceeding. Nothing contained herein shall prevent the Church from filing any action in a court of competent jurisdiction for the limited purposes of outlining and supervising the enforcement of the mandatory arbitration process and of issuing any injunctive or similar preliminary relief as may be deemed appropriate by such court in advance of the issuance of any arbitration award.
  20. This AUTHORIZATION, CONSENT, AND RELEASE agreement represents the entire understanding of the parties and may not be amended unless mutually agreed to by both parties in writing.

Date: November 13, 2026

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
First Participant's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
Third Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
Parent or Guardian's Email Address
Email*
Confirm Email*
Insurance
Insurance Carrier*
Insurance Policy Number*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
I am a:
Click to customize checkboxes *
Leader
Student
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 as an event participant understands and 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*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Information
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below, is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my child as follows:
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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