Youth Medical & Liability Form

Contents

Youth Medical & Liability Form
Youth Medical & Liability Form
Name of Participating Youth
Address
Name of Parent/Guardian
Emergency Contact

Youth Medical & Liability Form

Today's Date

Name of Participating Youth

First Name

Middle Initial

Last Name

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Birth Date

Name of Event

Date of Event

Name of Parent/Guardian

First Name

Last Name

Parent/Guardian Phone

Parent/Guardian Email

Emergency Contact

First Name

Last Name

Relationship to Youth

Emergency Contact Phone

Acceptance

I, the undersigned parent or legal guardian of the child named above, do hereby grant my permission and consent for the said child to attend and participate in the events and activities of Wayland Baptist Church Youth Ministry, both on and off church grounds, including the necessary transportation to and from these events and activities. Permission is granted for my child to receive medical care if: (1) such care is deemed necessary by the persons in charge of the event; (2) the proposed medical treatment or procedures are immediately or imminently necessary and any delay occasioned by an attempt to obtain my parental consent would reasonably jeopardize the life, health, or well-being of the child affected; (3) I cannot be personally contacted. I further agree not to hold Wayland Baptist Church or any of its paid staff or volunteers responsible for any accident that may occur on the way to, from, or during an event. I indemnify, defend and hold harmless Wayland Baptist Church for all claims made and liabilities assessed against them as a result of any event or activity. I release Wayland Baptist Church and all medical providers from liability in acting on my behalf in this regard and rendering such medical treatment. I assume the risk and financial responsibility for any injury resulting from any event or activity. Furthermore, I understand and assume the expenses of any property damage caused by my child. Should it be necessary that my child be returned home due to disciplinary action (when on trips or while on church property), I will be contacted by the leaders and will be responsible to pick my child up and assume the cost of transportation. By typing your name below and clicking the "I Accept & Submit Form" button, you are signing this Medical & Liability Release Form electronically. By signing, you agree that you are the parent/guardian of the youth mentioned above. You agree your electronic signature is the legal equivalent of your manual signature on this agreement. By selecting "I Accept & Submit Form" you consent to be legally bound by this Release Form's terms and conditions.

Signature of Parent/Guardian