Liability Release/Parental Consent:  In consideration for being accepted by your sponsoring church for participation at Bethel Youth Conference. We being 21 years of age or older, do for ourselves or myself and for and on behalf of my child particpant if said child is not 21 years of age or older, do hereby release, forever discharge and agree to hold harmless sponsoring church and Bethel Youth Conference and the directors thereof from any and all liability, claims or demands for 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 child participant that occur while said child is in participation in Bethel Youth Conference.

    Furthermore, we or I and o behalf of our/my child participant if under the age of 21, hereby assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein.  Furthermore, authorization and permission is hereby given to camp or church to any necessary transportation, food, lodging for this participant.

   The undersigned further hereby does agree to hold harmless and indemnify said camp and church, its directors, employees, and agents, for any liability sustained by said as a result of diligent, willful, or intentional acts of said participant, including expense incurred attendant thereto.

    We(I) authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray examination, anesthetic, medical surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the medical practice Act on the medical staff or a licensed medical hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

    The undersigned shall be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.  Should it be necessary for our (my) child to return home due to medical reasons, disciplinary action or otherwise, we do hereby assume all transportation costs.

   The undersigned does also hereby give permission for our child to ride in any vehicle by the adult in whose care the minor has been entrusted while attending and participating in teh activities sponsored by the Church.

Medical Information

Please list medication taken daily. Give meds to nurse.

   This health history is correct so far as I know, and the person herein described has permission to engage in all prescribed camp activities noted by me.  In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to hospitalize, secure treatment for, and to order injection,  anesthesia or surgery for my child as named above.

   We (I) have read and understand the Bethel Youth Conference Registration Policies.  We (I) give permissionfor the Bethel Ministerial Association to use photos of my child ( Me) in promotional literature, both now and in future publication, printed, or electronic.  In addition, I have read the Conference Guidelines and agree, on behalf of my child, to comply.

I hereby also give permission for my child 
to take part in the Youth Camp at the Bethel Conference Center in Dale, Indiana with Crosby Church.

Liability:
In consideration of the acceptance of the right to participate, entrants, participants, and spectators by execution of this form, release & discharge Crosby Church, the officers and members of Crosby Church and/or anyone else connected with management or presentation from any & all known and unknown damages, injuries, losses, judgments and/or claims from any causes whatsoever that may be suffered by any entrant to his/her person or property; further each entrant agrees to indemnify all the foregoing entries, firms, persons and bodies from any and all liability occasioned from the conduct of entrants or any participant assisting or cooperating with entrant and under direction or control of entrant.

Media Release:
In consideration of the foregoing event, participant, family and guests agree to permit Crosby Church use of their names, photographs for publicity & advertising (including newspapers, magazines, radio & television) before and after the event, and do hereby relinquish any rights to any such photographs taken in connection with the event, and give permission to publish or dispose of said photographs to Crosby Church.

Medical Care Release:
In addition I give my permission for proper medical care to be given to my son / daughter by the proper medical authorities in any case as is deemed necessary.

Transportation Release:
I hereby give my permission for my child the described participant to travel in appropriately supervised and safe transportation to and from any excursion associated with this event.