CBC Church Trip Release Form – Minors

Church Trip Release Form - Minors

  • Please enter a value between 10 and 60.
  • Medical Information

  • Activity/Trip Information

  • PHOTO AND VIDEO PERMISSION

  • By clicking yes, you grant permission for Crestwood Baptist Church to videotape or photograph your child or young person during the church event or normal activities. You understand these photos may be used as church promotional materials.
  • Emergency Contact Information

  • RELEASE, HOLD HARMLESS AND INDEMNITY

  • I, the undersigned, as parent or legal court appointed guardian of _____________________, a minor under the age of eighteen (18), (“Minor”), with full authority to act on behalf of Minor, do hereby agree and give my consent to the Minor participating in the Programs and Activities at Crestwood Baptist Church. I, on my own behalf and on behalf of Minor, acknowledge that participating in the Programs and Activities involve certain risks and that injuries, death, or other harm (including damage to Minor’s property) could occur to Minor (“Injuries”). By allowing Minor to participate in the Programs and Activities, I, on my own behalf and on behalf of Minor, hereby assume full responsibility for the risk of Injuries, whether caused by negligence or otherwise. I, on my own behalf and on behalf of Minor, and our heirs, successors, assigns, executors and administrators, hereby RELEASE AND HOLD HARMLESS AND AGREE TO INDEMNIFY Crestwood Baptist Church of Crestwood, Kentucky, Inc. and its staff, volunteer leaders, members, employees, deacons, council members, Ministry and Church Leadership (hereinafter collectively referred to as “CBC”) from and against any and all liability, claims, damages, causes of action, loss, costs and expenses (including, without limitation, attorneys fees) for Injuries arising out of or connected with the Programs and Activities, including traveling to and from the Programs and Activities.
  • MEDICAL CONSENT AND AUTHORIZATION

    If, while participating in the Programs and Activities, Minor requires emergency medical treatment, I hereby give my consent for any emergency medical care to be rendered to Minor as may be deemed necessary by any duly licensed physician or dentist. I hereby give my permission to CBC to obtain the emergency medical treatment at any hospital, clinic or other health care provider as may be deemed appropriate. In these circumstances, I hereby request and authorize any duly licensed physicians, dentists and staff, or other licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of Minor, including but not limited to medical transport, hospital tests, injections, anesthesia, surgery and administration of prescription drugs. I assume full responsibility for all medical expenses incurred as a result of such emergency treatment.
  • Signature will be required.
  • Required if under the age of 18.