Liability Form for Youth

Parent Info

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Home Church

Child Info

First Name

Last Name

Grade Completed

Birthdate

Phone Number

Allergies

T-Shirt Size

Release

Liability Release

In consideration of Bainbridge First Methodist Church allowing the above child(ren) to participate in youth activities, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless BFMC, its directors, employees, volunteers, and agents (collectively herein the “Church”) from any and all liability, claims, or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever that may be incurred by the undersigned and the above child(ren) while involved in youth activities. Furthermore, on behalf of my minor child(ren), I hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in activities involved therein. As well as releasing the child(ren), if necessary, for transportation to and from the location, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless BFMC, its directors, employees, volunteers, and agents from any and all liability, claims, or demands for accidental personal injury in the process of transportation.

Check to agree:

I agree to the above release.

Signature

Medical Release

I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child(ren) pursuant to this authorization.

Check if you agree to the above terms.

I agree to the above authorization.

Signature

Insurance Information

Name of insurance company

Text Input

ID number or Group number

Text Input

Any other insurance information

Text Input

Photo Release

I give my consent to BFMC to use photo or video images taken of my child(ren) in church brochures, advertisements for the church, on the website, in social media, and in other church publications as they see fit. I agree to hold harmless BFMC from any liability which may result from the use of said picture(s). This form will apply throughout my child(ren)’s tenure at BFMC Youth activities.

Type your new text here.

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Signature