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*
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*
Medical
Have you completed a 2025 Yearly Medical Authorization form?*

YesNo
Has anything changed or need to be updated on the 2025 Yearly Medical Authorization form?*

YesNo
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.I/we understand that, in the event medical treatment is required, every reasonable effort will be made to contact me. If I cannot be reached, I give my permission to the staff or sponsor to secure the services of a licensed physician to provide the necessary care, including anesthesia, for my student’s well-being.I consent to signing this document digitally and agree that a printed or digital copy of this signed agreement shall be equally valid and binding.
Parent/Guardian Name (Printed)*
Parent/ Guardian Signature. By my signature, I hereby acknowledge and agree to the terms and conditions contained herein. *

Clear
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