My child: may participate in all Church Student Ministry events for the 2021 calendar year. As a parent or guardian, I authorize an adult counselor to
I understand that First Baptist Church Dublin and First Baptist Dublin Student Ministry carries medical and hospitalization insurance coverage which, consistent with the exclusions, limitations and items thereof, may provide benefits over and above any personal medical and hospitalization coverages available to my family. I understand that any personal medical and hospitalization insurance available to my family will provide primary coverage and the ministry's medical and hospitalization coverage (subject to exclusions, limitations, and provisions in the ministry's policy) may provide secondary or excess vicarages available to my family, if any, before applying for benefits that may be available from the ministry's medical and hospitalization coverage.
I further understand that, in the event my child requires medical or dental treatment while engaged in the activity, reasonable efforts will be made to contact the persons listed on the form; however, if I cannot be reached, I nearby consent and give my permission to the ministry's sponsor or any adult counselor acting on behalf of the ministry with respect to the activity, as agent for me, to consent to any X-ray, examination, injection, anesthesia, medical, dental, or surgical diagnosis and treatment, and hospital care and treatment advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either as an outpatient or in any hospital.
To the best of my knowledge, I have listed above all of my child's medical allergies, medications being taken, medical diagnosis, and other pertinent information.
I understand all reasonable safety precautions will be taken at all times by First Baptist Church Dublin and its agents during the events and activities in which my child participates. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to not hold First Baptist Church Dublin, its staff, leaders, employees, and volunteer staff liable for damages, losses, diseases, injuries, or accidental death incurred by the subject of this form. I specifically understand that I am releasing, discharging, and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the staff, leaders, employees, and volunteer staff of First Baptist Church Dublin.
I have read the above waiver and release and by signing it agree it is my intention to accept and relieve First Baptist Church Dublin from liability for personal injury, property damage, or wrongful death caused by negligence or any other cause.