1st Student's Name *

First Name

Last Name

2nd Student's Name

First Name

Last Name

3rd Student's Name

First Name

Last Name

Physical Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

1) I consent to and approve my child/children’s taking part in any and all activities conducted by Bible Baptist Church Children/Youth programming. I understand that my child/children may participate in physical activities such as those held during games/activities. As with any physical activity, there is a risk of injury. I fully accept this risk and consent to the treatment of any minor injuries of my child/children, and release, hold harmless and indemnify Bible Baptist Church and their officers, directors, agents, employees and volunteers from any and all liability, claims and costs arising from or growing out of such treatment. In the event of an emergency that requires medical treatment for the above-named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the Bible Baptist Church volunteers to secure the services of a licensed physician to provide the care necessary for my child’s well-being. I assume responsibility for all costs connected to any accident or treatment of my child. 2) I give permission for photo(s) of my child/children to appear among other general club photos in any and all media as long as there is no identifying information published by Bible Baptist Church. *

I have read the Terms & Conditions stated above.

Parent / Guardian Electronic Signature *

First Name

Last Name