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Fall Nighter 2024 Waiver

Student must have be in 6th-12th grades in the 2024-2025 school year.

This form must be filled out and signed by each student's parent or legal guardian.



Medical Release: As the participant, parent, and/or guardian (if under 18 years of age) of said member, I hereby consent and give my permission to Henderson Hills Baptist Church, its representatives, or any medical provider to make such decisions, to perform diagnostic testing and medical treatment, which may in their sole discretion be necessary and proper under the circumstances. Treatment may include over-the-counter medications such as Tylenol, Ibuprofen, Allergy medicine, Pepto Bismol, etc... As the participant, parent, and/or guardian of said member, I hereby do release, acquit, discharge to hold harmless Henderson Hills Baptist Church or its representatives or any attending physician from any and all actions, damages, or liabilities arising out of the treatment of any sickness or accident incurred by above said participant during this church activity.

I Agree

No Tolerance Policy: I understand that HHBC has a No Tolerance Policy that includes verbal or non-verbal harassment, sexual misconduct, threatening behavior, intimidation, and bullying. Any child that jeopardizes the safety and care of another person will be sent home at the parents’ expense and with no refund.

I Agree

Photo/Video Release: I give Henderson Hills Student Ministry the right to use video or still-shot photography of my student for any appropriate promotional or publicity use.

I Agree

Parent or Legal Guardian Signature unless 18 or older.

February 5, 2025





First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
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*
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*

Phone*
Parent or Guardian's Date of Birth*
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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