MEDICAL INSURANCE INFORMATION
• I do hereby verify the information given on this form is correct. • I do hereby give permission for my above-named child to participate in and to be transported to and from ALL activities, events, retreats or trips sponsored by the Student/Children’s Ministry of Trinity Baptist Church, Danielsville, GA during 2018. • I understand that this permission/release will apply to all planned activities, events, retreats or trips sponsored by the Student/Children’s Ministry of Trinity Baptist Church during the 2018 year, • I understand that, in the case of an emergency Trinity Baptist Church, employees, agents and/or sponsors will make every effort to contact me and/or the contact person named below, however; • Should the named contact person, or myself, be unavailable to make decisions regarding my child’s care, I do hereby grant permission for Trinity Baptist Church employees, agents and/or sponsors to obtain emergency medical attention in case of sickness or injury, to my child. • Should the named person or myself, be unavailable to make decisions regarding my child’s care, I do hereby grant permission for an attending physician or hospital to perform whatever care is deemed necessary by Trinity Baptist Church employees, agents and/or sponsors for the welfare of my child.
In consideration for you allowing my child to go on said activities, events, retreats or trips:
• I hereby release, absolve, indemnify, hold harmless, and forever discharge Trinity Baptist Church, its employees, agents, organizers, sponsors, or any supervisors appointed by them from any and all claims, demands, actions or cause of actions, past, present, or future arising out of injury or damage to my child while participating in any activity, event, retreat or trip.
• I assume all risks and hazards incidental to the conduct of the activities, events, retreats or trips and transportation to and from these activities, events, retreats or trips. In case of injury to my child, I hereby waive all claims against Trinity Baptist Church, its employees, agents, organizers, sponsors, or any supervisors appointed by them. I likewise release from responsibility any person transporting my child to and from said activities, events, retreats or trips.
• I agree that any dispute, claim, questions, or disagreement arising out of or relating to said activities, events, retreats or trips, which cannot be otherwise resolved shall be submitted to mediation and if necessary legally binding arbitration as adopted by church leadership. As a result, I expressly waive any and all rights at law and equity to bring any civil matter before a court of law, except that judgment upon the award rendered by the arbitrator may be entered in any court have jurisdiction thereof.
• I agree to provide medical insurance for my child and/or agree to be responsible for any possible medical bills associated with my child.
I understand that Trinity Baptist Church regularly photographs, videotapes, or records by other visual or sound recording devices during our worship services, LIFE Group/Sunday school and other church sponsored activities, events, retreats and trips. In consideration for allowing my child to participate in said activities, events, retreats and trips, I consent to my child’s photograph, likeness or image being used by Trinity Baptist Church in video presentations, publications, promotions, on their web site or in any other lawful manner.
* I certify that I am the parent or legal guardian of the above minor and confirm that the information I entered is accurate and true.
* I am at least 18 years old and I have read and agree to the terms of the above agreement.
* By typing my full name below, I am electronically certifying this waiver document just as if I would physically sign it if it was on paper.