Youth's Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Youth Phone

(###)

###

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Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I give permission for Emmanuel Baptist Church to use photos of my child from church events. *

For internal use only

For both internal and external use

Do not use my child's picture

In case of emergency, if I can't be reached, please contact: *

(###)

###

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Sign me up to receive the Monthly Scoop newsletter *

Yes, please!

No, thanks!

Release of Liability *

As the legal guardian of this child, I give consent for them to participate fully in youth group activities. IN CONSIDERATION OF Emmanuel Baptist Church allowing me or my child to participate in the activities, I agree on behalf of myself and/or my child: TO ASSUME and ACCEPT ALL RISKS arising out of, associated with, or related to my or my child's participation in the activities. I WAIVE and RELEASE Emmanuel Baptist Church and it's volunteers from any and all liability for any loss, damage, injury, or expense that I or my child my suffer, or that my next of kin may suffer as a result of participation in youth group activities due to any cause whatsoever. I INDEMNIFY and HOLD HARMLESS Emmanuel Baptist Church and volunteers from any and all liability for damage to personal property, or personal injury to any third party resulting from participation in youth group activities. I INDEMNIFY and HOLD HARMLESS Emmanuel Baptist Church and volunteers from any and all claims, demands, actions, and costs for any loss, injurty, damage, or expense that might arise out of my child's participation in youth group activities. I INDEMNIFY and HOLD HARMLESS Emmanuel Baptist Church and all its officers, agents, volunteers, and employees, acting officiallly or otherwise from any and all actions, claims and demands for, upon, or by reason of injury, damage, loss, or death which may occur from any cause including but not limited to any accident while participating individually or with others in youth group activities. Whereas I plan for my child to participate in Youth Group and related activities, I hereby consent to and authorize emergency medical care of the Participant as may be advisable in the event of accident, injury, or illness during youth group activities.

I agree