Lakeside Minor Under 18 Consent & Release

CONSENT AND RELEASE FOR A MINOR UNDER 18 TO PARTICIPATE IN CHURCH EVENTS

This Document Contains IMPORTANT INFORMATION.Please READ IT CAREFULLY Before Agreeing To The Terms And Conditions!
Child's Name
Date of Birth

MonthDayYear
Date
Parent/Guardian Name(s)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone
Format: (000) 000-0000.
For verification please upload a valid photo identification. (Drivers license, a state issued photo ID, or a Passport)

Cancelof
Email
example@example.com
Ministry and Event
Which Ministry Has Requested this Consent?
What is the Name of the EVENT that the participant will be attending?
Ex. Winter Retreat, Kids Camp, VBS, etc.
Date(s) of Event
Ex. 2/10/24 - 2/12/24
Emergency Contacts
Relationship to Minor
First & Last Name
Emergency Contact Phone
Format: (000) 000-0000.
Medical
Have you completed a 2025 Yearly Medical Authorization form?
Has anything changed or need to be updated on the 2025 Yearly Medical Authorization form?
For your convenience the Yearly Medical Authorization form will launch after you submit this form for you to complete and submit.
Please list any allergies, medications being taken, medical problems, etc.
CERTIFICATION, AGREEMENT & SIGNATURE

I /we certify that I am the parent and/or legal guardian of the minor; and that I am at least eighteen (18) years of age and of sound mind; and I have carefully READ, UNDERSTAND, AND AGREE to give my child permission to attend the EVENT that will be taking place on the DATE(s) listed on this document. I also agree to the method of transportation that Lakeside Baptist Church chooses as transportation to and from this EVENT.
Parent/Guardian Name (Printed)
Parent/ Guardian Signature. By my signature, I hereby acknowledge and agree to the terms and conditions contained herein.
Today's Date

MonthDayYear
Date
Should be Empty:

CONSENT AND RELEASE FOR A MINOR UNDER 18 TO PARTICIPATE IN CHURCH EVENTS

Ministry and Event

Emergency Contacts

Medical