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2026- BSM Annual Permission /Consent /Liability Release and Student Covenant Form
This form must be completed and returned to the Bethel Student Ministry before any student may participate in any Bethel Students activity or event. -There are sections of this form for both the parent/guardian and the student participant to initial and/or sign. Please be sure both parties are present. -Parents/Guardians, please review the various sections of the permission/release/waiver with your student, and go over the code of conduct with them, to ensure you both understand what you are agreeing to. -For your convenience we have created a digital version of this form. In this case, we are assuming that by typing your initials and/or legal name on this document and its various sections it will serve the same purpose as signing/initialing it on a paper form. Bethel Baptist Church will keep an electronic version of your 'signed' document and may also print it for historical/archival purposes.
Legal First & Middle Name
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Legal Last Name
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Age
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Date of Birth
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Month
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Day
Year
Date
School
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Grade
*
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
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PARENT/GUARDIAN & FAMILY CONTACT INFORMATION
Parent/Guardian Name(s)
Parent/Guardian Cell Phone Number
*
Parent/Guardian Work Phone Number
Primary Family Mailing Address (include Street, City, State, and Zip)
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Primary Family Phone Number
*
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MEDICAL INFORMATION
Covered by medical insurance?
Yes
No
Insurance Company
Policy/Group ID #
Allergies or Medical Conditions:
Prescriptions or Medicines:
If needed, do you authorize giving pain medicine (e.g. Tylenol or Advil) to your student?
Yes
No
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EMERGENCY CONTACT INFORMATION
Name of Emergency Contact (if Parent/Guardian cannot be reached)
Relationship to Participant
Phone Number
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PERMISSION
TO WHOM IT MAY CONCERN: The undersigned hereby give(s) permission for our (my) child (“Participant” listed above) to attend and participate in Bethel Student Ministries activities, events, and retreats from January to December 2025. Including, but not limited to: Bible Fellowship Classes/Activities, Community Groups, Missional Summer Events, Summer Nights, The Gathering, D-Now, Spring and Fall Retreats, Student Leadership Retreat, Youth Evangelism Conference, Mission Trips, and Summer Camp. Additional forms may be required for specific camps/locations.
Parent/Guardian Initials for Permission
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LIABILITY RELEASE
In consideration of Bethel Baptist allowing the Participant to participate in Bethel Baptist Student Ministries activities, we (I), the undersigned, do hereby release, forever discharge and agree to hold harmless Bethel Baptist, its directors, employees, volunteers and agents (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the youth activities. We (I), the parent(s) or legal guardian(s) of this Participant, hereby grant our (my) permission for the Participant to participate fully in Bethel Baptist Student Ministries activities, including trips away from the church premises. Furthermore, we (I) [and on behalf of our (my) minor Participant(s)] hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein. Authorization and permission is hereby given to the Church to furnish any necessary transportation (within the limitations of church insurance and the law), food, and lodging for the Participant. The undersigned agree(s) to hold harmless and indemnify the Church for any liability sustained by the Church as a result of negligent, willful or intentional acts of Participant, including expenses incurred attendant thereto.
Parent/Guardian Initials for Liability Release
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MEDICAL TREATMENT PERMISSION
We (I) authorize an adult, in whose care the minor Participant has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care to be rendered to the minor Participant under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned minor Participant pursuant to this authorization.
Parent/Guardian Initials for Medical Treatment Permission
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EARLY RETURN HOME POLICY
Should it be necessary for our (my) child or youth to return home due to medical reasons, disciplinary action, or otherwise, the undersigned shall assume all transportation costs and responsibility.
Parent/Guardian Initials for Early Return Home Policy
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TRANSPORTATION PERMISSION
The undersigned does also hereby give permission for our (my) youth to ride in any vehicle driven by an approved ADULT chaperone while attending and participating in activities sponsored by the Church. My child and I understand that SEAT BELTS SHALL BE WORN AT ALL TIMES during transportation.
Parent/Guardian Initials for Transportation Permission
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PHOTOGRAPH / VIDEO PERMISSION
All photos, videos, and audio tapes of my child captured by Bethel Baptist Student Ministries is also released to Bethel Baptist for promotional purposes such as brochures, videos, web pages, etc.
Parent/Guardian Initials for Photograph/Video Permission
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STUDENT COVENANT OF CONDUCT
My child and I understand that the Bethel Baptist Student Covenant of Conduct is applicable to the Participant at all times while involved with Bethel Baptist Student Ministries and the sponsored activities and events. My child and I agree to: • Recognize that everyone in the group is a part of the body of Christ. I will help everyone feel welcome and important. • Respect the physical and emotional well-being of others by “doing unto them as I would have them do unto me.” This includes refraining from harsh play or violence, refraining from harmful jokes, respecting the need for sleep, etc. • Respect the health of my own body by refraining from the use of tobacco, alcohol, illegal drugs and weapons. I understand that the use of these substances is absolutely prohibited. They will be confiscated and parents and/or authorities contacted immediately. • Respect the things I use and the property of the places I visit. The areas used for all events, including transportation, shall be left clean. • Participate fully in all scheduled group activities and abide by additional group guidelines made during a special event or trip. • Act appropriately with members of the opposite sex. This means no couples alone at any time, and no public displays of affection. • Follow all instructions given by leaders/chaperones without protest. An instruction may be politely and discreetly questioned. • Stay within the group or assigned sub-group at all times. I will not wander off alone or leave the activity site unless granted permission by an adult, and I will report for all designated check-in times. • Hold safety in the highest regard, and refrain from compromising my own safety or another’s safety. • Provide a trusting environment for my peers. When others share something about themselves in a group discussion, I will not repeat that information outside of the group. • Take the initiative to inform my guests of their responsibility to follow these guidelines when they visit or participate in an event.
Parent/Guardian Initials for Student Covenant of Conduct
Student Participant Initials for Student Covenant of Conduct
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GUIDELINES FOR CONSEQUENCES
Consequences will focus on restoring peace with reconciliation among the parties involved. The goal of resolving each problem will be growth and learning through repentance and forgiveness. Any problems encountered will be handled within the group and by the adult leaders to the extent that this is possible. However, should a situation persist or become uncontrollable, the parent/guardian will be contacted and informed of the problem. Should the situation be urgent, the parent/guardian will be contacted immediately and will be responsible for picking up the minor Participant from an event or providing for his/her transportation home.
Parent/Guardian Initials for Guidelines for Consequences
Student Participant Initials for Guidelines for Consequences
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STUDENT/PARTICIPANT AND PARENT/GUARDIAN SIGNATURES
My signature on this Annual Permission / Consent / Liability Release and Student Covenant Form is an acknowledgement that I have read and understand these guidelines. I recognize that this is a permission slip, medical release, liability release, and covenant for January-December 2025. I commit to abide by the provisions of this Release Form and submit to Bethel Baptist's Student Ministries.
Parent/Guardian Signature (please type your full legal name as indication you are signing this document)
Parent/Guardian Date of Signature
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Month
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Day
Year
Date
Student/Participant Signature (please type your full legal name as indication you are signing this document)
Student/Participant Date of Signature
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Month
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Day
Year
Date
Submit
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