2024 Kids Ministry Participant Permission & Medical Release

2024 Hebron Church Kids Ministry Participant Permission & Medical Release

This form is for all 2024 Kids Ministry activities, events, retreat, and trips.
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Age*
Grade*
Parent/Guardian Name*

First NameLast Name
Relationship to Child:*
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone*
Please enter a valid phone number.
Parent/Guardian Alternate Phone
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If my child makes a decision to be baptized, I give HBC permission:

YesNo
Medical Information
Family Insurance Company*
Policy Number*
Family Physician*
Phone Number of Physician*
Please enter a valid phone number.
List allergies here:*
Foods, medications, insects, etc.
Can your child take the following?*

TylenolAdvilBenadrylOther
Please list any medical conditions your student may have, medications he/she is taking, or any other information about your child you think we need to be aware of so that we can help him/her to have the best experience possible.*
Immunization for Tetanus Date:*

MonthDayYear
Date
Emergency Contact Information

If I am not available, contact:
Emergency Contact 1 Name
Emergency Contact 1 Number
Emergency Contact 2 Name
Emergency Contact 2 Number
Permissions & Waivers
Permission
- I do hereby verify the information given on this form is correct.
- I do hereby give permission for my above-named child to participate in and to be transported to and from ALL activities, events, retreats or trips sponsored by the Children’s Ministry of Hebron Baptist Church, Dacula, GA during the church year of 2024. This includes but is not limited to the VBS, Children’s Summer Camp, Mission Summer Day Trips, Bowling (Feb) and Back to School Swim Party (July) any other on or off campus activities.
- I understand that this permission/release will apply to all planned activities, events, retreats or trips sponsored by the Children’s Ministry of Hebron Baptist Church during the 2024 year.
- I understand that each of these activities, events, retreats or trips involve certain risk both known and unknown. These risks include but are not limited to, damage to property, serious bodily injury, or death.
- I understand that in the case of an emergency, Hebron Baptist Church employees, agents and/or sponsors will make every effort to contact me and/or the contact person named below, however; should the named contact person, or myself, be unavailable to make decisions regarding my child’s care, I do hereby grant permission for Hebron Baptist Church employees, agents and/or sponsors to obtain emergency medical attention in case of sickness or injury, to my child.
- Should the named person or myself, be unavailable to make decisions regarding my child’s care, I do hereby grant permission for an attending physician or hospital to perform whatever care is deemed necessary by Hebron Baptist Church employees, agents and/or sponsors for the welfare of my child.
Hold Harmless

In consideration of Hebron allowing my child to go on said activities, events, retreats, or trips and other valuable consideration the receipt of which is acknowledged:
- I hereby release, absolve, indemnify, hold harmless, and forever discharge Hebron Baptist Church, its employees, agents, organizers, sponsors, or any supervisors appointed by them from any and all claims, demands, actions or cause of actions, past, present, or future arising out of injury or damage to my child while participating in any activity, event, retreat, or trip.
- I assume all risks and hazards, whether known or unknown, incidental to the conduct of the activities, events, retreats, or trips and transportation to and from these activities, events, retreats, or trips. In case of injury to my child, I hereby waive all claims against Hebron Baptist Church, its employees, agents, organizers, sponsors, or any supervisors appointed by them. I likewise release from responsibility any person transporting my child to and from said activities, events, retreats, or trips.
- I agree that any dispute, claim, questions, or disagreement arising out of or relating to said activities, events, retreats, or trips, which cannot be otherwise resolved shall be submitted to mediation and if necessary, legally binding arbitration as adopted by the Administrative Pastor and legal counsel. As a result, I expressly waive any and all rights at law and equity to bring any civil matter before a court of law; except that judgment upon the award rendered by the arbitrator may be entered in any court have jurisdiction thereof.
- I agree to provide medical insurance for my child. I agree that in the event my child causes damages, I will take full financial responsibility for the damages, and should an early return home be warranted, due to disciplinary concerns, I will provide transportation home for my child.
Photography Consent

I understand that Hebron Church regularly photographs, videotapes, or records by other visual or sound recording devices during our worship services, Connect Groups and other church sponsored activities, events, retreats and trips. In consideration for allowing my child to participate in said activities, events, retreats, and trips, I consent to my child’s photograph, likeness or image being used by Hebron Church in video presentations, publications, promotions, on its website or in any other lawful manner.
I am the parent or legal guardian of the child/participant whose name appears above. I have read and understand this Permission, Waiver, Release and Indemnification Agreement, and consent on behalf of myself and the Participant to its terms.
Should be Empty:

2024 Hebron Church Kids Ministry Participant Permission & Medical Release

Medical Information

Emergency Contact Information

Permissions & Waivers