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Faith Children’s Ministry 2024/2025 Release Form



AUTHORIZATION AND WAIVER FORM: I authorize the listed children to participate in Faith Baptist Church (the Church) Children’s Program, including any transportation provided by the Church for the activity for the 2024-2025 school year (September 1-August 31). If the parent or guardian cannot be contacted at the phone number(s) listed above, I give my permission to any leader to administer medication and to authorize any medical treatment that may be reasonably necessary for the participant and give permission to the attending physician, dentist, or other health care provider to provide such treatment. I agree that my medical insurance plan is the primary plan to pay for any medical treatment given to the participant.

WAIVER: I understand that while the Church will take reasonable precautions, the activity (including any transportation provided for the activity), involves the possibility of unforeseeable risks. In exchange for the Church allowing the participant to participate in the activity, I waive and I release and discharge the Church, their related ministries and organizations, and each of their elders, directors, officers, managers, employees, volunteers, members, and agents from any and all claims, losses, or expenses arising from or related to the activity. I also agree to indemnify, hold harmless, and defend the Church and each of the other parties listed above with regard to such claims, losses, or expenses, including without limitation any claims made by or on behalf of the participant.

I HAVE READ AND FULLY UNDERSTAND THIS FORM. I UNDERSTAND THAT I AM WAIVING AND RELEASING ANY CLAIMS. By registering your child, you give us permission to use photos or videos captured by our staff that may include your child for use by Faith Baptist Church. Participants less than 18 years old: Parent or guardian sign below. I understand and agree to be bound by this Authorization and Waiver and sign it both in my capacity as parent or guardian and in a representative capacity on behalf of my child.

Today's Date: October 22, 2024


First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Insurance / Medical Information

INSURANCE INFORMATION: (For Medical Emergency Purposes Only)


Medical Insurance Provider

Phone

Employee

Employer

Phone

Group #

ID #

Other Necessary Info for Medical Personnel:
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*
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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