Immanuel Child/Youth Activity Waiver

Immanuel's Children/Youth Activity Waiver
Child's Legal Name

First NameLast Name
Birth Date

MonthDayYear
Desired Name
Grade currently
Students Mobile Number (Grade 6 and up only)
Students Email Address (Grade 6 and up only)
example@example.com
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide any allergies or accommodations needed

Family Information
Parent/Guardian's Name 1:

First NameLast Name
E-mail Address 1:
example@example.com
Contact Phone Number 1:
Parent/Guardian's Name 2:

First NameLast Name
E-mail Address 2:
example@example.com
Contact Phone Number 2:
Emergency Contact Information
Emergency Contact Name 1:

First NameLast Name
Emergency Contact Phone Number 1:
Relationship to Student 1:
Emergency Contact Name 2:

First NameLast Name
Emergency Contact Phone Number 2:
Relationship to Student 2:

Permissions
The undersigned parent/legal guardian hereby permits Immanuel Baptist Church, for my child, name above, to take part in in children/youth activities sponsored by Immanuel Baptist Church, including, but not limited to, (children/youth Sunday School and Worship activities, Wednesday night activities, local mission activities, mission trip activities, children/youth special field trips)

Should my child require immediate or emergency medical care while engaged in an activity sponsored by the Church, in my absence, I hereby grant the Church authority to release my child for medical treatment to such medical personnel as the Church determines appropriate under the circumstances.

In consideration for the privilege of allowing my child to participate in the above-named activity, I agree to release and hold harmless the Church, its officers and agents, from any liability to or responsibility for bodily injury, damage or illness to the above-identified child while participating in any youth athletic or social activity which may be directly or indirectly sponsored by the Church. Further, I agree to indemnify and hold harmless the Church, its officers and agents with respect to any claim asserted by or on behalf of my child as a result of bodily injury, illness, or damage.

PLEASE READ CAREFULLY, THIS PERMISSION SLIP IS A LEGAL DOCUMENT WHICH INCLUDES A RELEASE OF LIABILITY AND INDEMNIFICATION
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Permission for the use of Photography and VideoDuring events and activities at/or sponsored by Immanuel Baptist Church, I acknowledgethat photos and/or videos may be taken that include my child (named above).

I grant my permission for these photos/videos of my child (named above) may be used on Facebook, Instagram, Website, and/or presentations of Immanuel Baptist Church.I do not give permission for photos/videos of my child (named above) to be used on Facebook,Instagram, Website, and/or presentations of Immanuel Baptist Church.
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Immanuel's Children/Youth Activity Waiver

Family Information

Emergency Contact Information

Permissions