PARENT AUTHORIZATION, CONSENT AND RELEASE

I, ___________________________________ am the parent or legal guardian of
_________________________________ who was born on ___________ , 20____,
and is currently in ________ grade.
I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.
As the parent or legal guardian of _________________________________, I certify and affirm that I have been completely and thoroughly informed that as a youth attending Memorial Baptist Church, my child will participate in certain activities which carry with them a degree of risk and danger.
Examples of risky and dangerous activities include, but are not limited to:
Physical activities, both indoors and outdoors;
Sports, both informal and organized;
Use of recreational equipment;
Field trips, both on and off campus;
Travel by automobile or bus;
Activities around water, including swimming and boating;
Hiking; and
Camping
I  acknowledge  and  understand  that  Memorial  Baptist  Church  may  offer  other activities not listed above that present similar risks or dangers to my child.
I consent to my child's participation in these activities. I acknowledge and understand that this PARENTAL AUTHORIZATION, CONSENT AND RELEASE has the same force and effect regardless of whether the activities engaged in are free or if a fee is charged.
Further, I personally assume, on my child's behalf, all risk in connection with said activities for any harm, injury or damages that may befall my child as a result of my child's participation in the activities, whether foreseen or unforeseen, and I still wish to allow my child to proceed with the activities
In consideration of my child being allowed to participate in these activities and to use Memorial Baptist Church’s equipment and facilities, on behalf of my child, I hereby voluntarily release, forever discharge, and agree to identify and hold harmless Memorial Baptist Church from any and all claims, demands, or causes of action, which are in any way connected with my child's participation in these activities or use of Memorial Baptist Church's equipment and facilities.
In cases of emergency, I further consent to the examination or treatment of my child by a physician duly licensed to practice medicine in this State or any health care professional duly licensed to provide health care services in this State for medical care and services deemed necessary by Memorial Baptist Church, its agents, servants, and employees.
I give permission to the Doctor or health care professional  to provide any and all medical care they deem, in their professional opinion, to be necessary.
I agree to pay for any and all medical expenses incurred as a result of the use of this consent.
I understand that it is my obligation to inform the management of Memorial Baptist Church of any and all health considerations or medical conditions that would restrict my child's participation in any and all activities while at Memorial Baptist Church.
Should the need for medical attention arise, Memorial Baptist Church will attempt to contact me, as soon as practicable under the circumstances.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my child's participation in these activities, I may be found by a court of law to have waived my right to maintain a lawsuit against Memorial Baptist Church on the basis of any claim from which I have released them herein.
 Medical Information
Allergies__________________________________________________________
Medications being taken____________________________________________
Physical handicaps or limitations_____________________________________
Medical insurance company__________________________________________
Policy number____________________ Members Name____________________


I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
I have fully informed myself of the contents of this PARENTAL AUTHORIZATION, CONSENT AND RELEASE by reading it before I signed it.


___________________________________
Signature

___________________________________
Printed Name

___________________________________
Date

___________________________________
___________________________________
Address
___________________________________
Phone






Student events always provide us opportunities to photograph your student and be able to showcase what they are doing. However, in order t put any photo or video on any social media site we will need you to indicate whether or not you would like for us (Memorial Student Ministry) to do that.

_______ I DO grant permission for still photos, videotape or interviews with my child to be used by Memorial Baptist Church and/or Memorial Student Ministry to be used on social media sites.

______ I DO NOT grant permission for still photos, videotape or interviews with my child to be used by Memorial Baptist Church and/or Memorial Student Ministry to be used on social media sites.

I am the parent/guardian of _______________________________________ and agree to
indemnify and hold harmless Memorial Baptist Church, its agent, trustees, employees and volunteers from any and all damages, injuries, or causes of action, which may result from the photography of my child or the publication thereof.

Parent Signature__________________________________________
Student Name____________________________________________
Date Signed_______________________________ Grade_________

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