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Country Bible Youth Group All-Year Participation Agreement, Media Permission & Medical Release Form September 2008 to September 2009 Country Bible Church (CBC) welcomes your child’s participation in the Youth Ministry Program. It is necessary however, for CBC and you to have an understanding regarding CBC’s responsibility and your responsibility in the event of an accident or illness involving any participant in the Youth Ministry Program. We, therefore, ask you to read and agree to the following terms and conditions: Participation Agreement I, the parent and/or legal guardian of ____________________________, consent to allow my child to participate in the youth group conducted by CBC. In consideration of my child being allowed to participate in the youth group, I hereby acknowledge and agree as follows: 1) My child’s participation in the youth group is entirely voluntary . 2) CBC shall not be responsible for any of my child’s personal property that is lost or damaged by fire, theft, or by other participants. 3) CBC reserves the right to dismiss, temporarily or permanently, any participant whose conduct is deemed, by the youth directors, to be detrimental to my child, other participants, staff or any aspect of the youth group. 4) I understand that my child may travel to or from various youth group activities in vehicles driven by a driver approved by the directors of the youth ministry. 5) My child has health insurance coverage appropriate for his/her participation in the youth group. I understand that CBC does not provide any insurance for my child in connection with his/her participation in the youth group. 6) I hereby agree I will not sue or make claims against and I will forever release, indemnify and hold harmless CBC, its employees, agents, successors and assigns, singularly and collectively, from and against any blame and liability for any injury, harm, loss, inconvenience or any other damage of any kind whatsoever, which may result from or be connected in any way to my child’s participation in youth group activities. 7) I agree that this release covers each and every time my child participates in any activity of CBC, whether on premises owned or operated by CBC or at any other location. Media Permission   Yes, I consent that CBC may use photos or video of my student in church publications or on their weblog or website. No, Please do not post pictures of my student on CBC’s publications, weblog or web site.

All Year Participation Agreement and Medical Release Form

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Country Bible Youth GroupAll-Year

 

Participation Agreement, Media Permission & MedicalRelease Form

September 2008 to September 2009

Country Bible Church (CBC) welcomes your child’s participation in the Youth MinistryProgram. It is necessary however, for CBC and you to have an understanding regardingCBC’s responsibility and your responsibility in the event of an accident or illnessinvolving any participant in the Youth Ministry Program. We, therefore, ask you to readand agree to the following terms and conditions:

Participation Agreement

I, the parent and/or legal guardian of ____________________________, consent to allow mychild to participate in the youth group conducted by CBC. In consideration of my childbeing allowed to participate in the youth group, I hereby acknowledge and agree asfollows:

1) My child’s participation in the youth group is entirely voluntary.

2) CBC shall not be responsible for any of my child’s personal property that is lost ordamaged by fire, theft, or by other participants.

3) CBC reserves the right to dismiss, temporarily or permanently, any participant whoseconduct isdeemed, by the youth directors, to be detrimental to my child, other participants, staff orany aspect of the youth group.

4) I understand that my child may travel to or from various youth group activities invehicles driven by a driver approved by the directors of the youth ministry.

5) My child has health insurance coverage appropriate for his/her participation in theyouth group. Iunderstand that CBC does not provide any insurance for my child in connection withhis/herparticipation in the youth group.

6) I hereby agree I will not sue or make claims against and I will forever release,indemnify and hold harmless CBC, its employees, agents, successors and assigns,singularly and collectively, from and against any blame and liability for any injury, harm,loss, inconvenience or any other damage of any kind whatsoever, which may result fromor be connected in any way to my child’s participation in youth group activities.

7) I agree that this release covers each and every time my child participates in anyactivity of CBC, whether on premises owned or operated by CBC or at any other location.

Media Permission

  Yes, I consent that CBC may use photos or video of my student in church publicationsor on

their weblog or website.

No, Please do not post pictures of my student on CBC’s publications, weblog or website.

 

Medical Release

 ____________________________________ ________________________________________________ 

Parent/Guardian Name (printed) Parent E-mail

 _____________________ ________________ ____________ ______________________________ 

Student Name (printed) Student Birth Date Student Grade Student School

  ______________________________ ______________________________ ___________________ 

Home Address City, State, Zip Home Phone

  _______________________ ____________________________ ____________________________ 

Parent Work Phone Parent Cell Phone Other Parent contact

  ______________________________ ____________________________ 

Name of emergency contact Emergency Contact Phone

Special Medications or Allergies: _________________________________________________________ 

 ______________________________ ______________________________  

Family Doctor Name Doctor Phone

 ______________________________ ___________________ _________________________  

Insurance Company Group # Policy #

In the event that my child is injured and I cannot be reached, I grant permission to theadult in charge of my son/daughter to grant permission for emergency medicaltreatment and I agree to be financially responsible for that treatment.I have read and understand the above provisions and it is my intention that by signingbelow I will bind myself, my spouse, the participant, and my and the participant’s heirs,successors, executors, estate and dependents to the terms stated above.

 ____________________________________ ______________________________ 

Parent/Guardian Signature Date