Student Ministry Release Form

Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Another adult in case of emergency

First NameLast Name

Phone Number

Please enter a valid phone number.

Name (Child 1)

First NameLast Name

Name (Child 2)

First NameLast Name

Activity and Event(s): All Student Ministry Activities, Events, and Games

January 2025-January 2026

Acknowledgement of Risk and Grant of Permission

I, acknowledge that I am the Parent/Guardian for above stated student(s) and am aware of and have investigated to the extent necessary all dangers and risks inherent in the activity/event(s) including the risk of serious bodily injury or death. I agree to indemnify and hold harmless, BELIEVERS BAPTIST CHURCH and its Elders, employees, agents, volunteers and/or officers (collectively “BBC”) from any liability arising from participation in all Awana activities, events, and Games. It is further acknowledged that any BBC activity/event may involve transportation in a personal vehicle, van or a bus. The terms of this release form shall be construed as the entire agreement and may not be altered, amended, or modified except in writing and signed by both parties. The terms of this release shall be governed by the laws of the State of Texas.

Emergency: I hereby grant permission and authority to BBC, to act for us in executing verbal instructions or if unable to contact us, to act for us in dealing with physicians, available ambulance companies and hospitals, to obtain, prompt medical attention for the participant named above in the event of any perceived medical emergency. I hereby covenant and agree to release BBC, and hold harmless from any liability connected with obtaining prompt medical attention for the named above. It is further understood that I will be responsible for the costs of all medical services obtained pursuant to this authorization.

Image: In connection with participation in the above listed event/activity, I/we understand, (if minor, parents/guardian) hereby grant to BBC, the right to use participant’s name, image and/or interviews in all forms of media including advertising and related promotion. I/we release BBC, from any claim that may arise regarding such use, including claims of defamation, invasion of privacy, or infringement of rights of publicity or copyright.

Date:blank Signature