Medical Release Form

Medical Release Form Entry

Added: 8/14/2022
My/our consent is hereby given for Calvary Bible Church (hereinafter CBC), its staff, leaders, chaperones, counselors or other representatives responsible for the CBC ministries/group to consent to and obtain any and all medical, dental or other health care deemed reasonably medically necessary by a qualified health care professional(s) for my child in the event of any sickness or injury occurring to my/our said child while present and/or participating in the events and activities of said youth ministries/group. I understand that this form is valid to be used for any event during the period of exactly two years beyond the date I sign this release. I understand that in such event, while every reasonable effort will be made to contact me as soon as is practicable, such contact may not occur until much later. I also know that if any medical or insurance information changes that I need to notify the leaders in written form to add to this form. By signing this form, as parents we agree that our child: 1) May participate in any planned or reasonably anticipated activities of the youth group (e.g. C-Team, SWAT, Work Weekends, Sunday School/Basic Training, Overnight Retreats or other). 2) Has the physical abilities required to so participate. 3) Does not have any known but undisclosed physical, mental or emotional condition that would make his/her said participation unreasonable, dangerous, harmful or otherwise inadvisable for him/her.
I further authorize any medical facility to discuss my childs case and care in detail with the authorized representatives/leaders of Calvary Bible Church and its ministries/group, including the ministries checked above and the church office, so that you as a medical facility can assist them in treatment of my child.
By allowing our child to partake as a participant in the ministries or event being sponsored and/or conducted by CBC, including but not limited to: weekly programs, campouts, lock-ins, retreats, fundraisers, movie nights, outings, roller/ice skating, photo scavenger hunts, work weekends, various sports, other outdoor activities and any needed transportation provided by CBC or CBC chaperones/leaders for events & activities. As parents, and on behalf of our child, we agree that we will not hold CBC its board, officers, staff, employees, volunteers or other agents liable for any injury, loss, damage or accident that he/she might encounter in the course of participating in the any reasonable and planned activities of the group/ministry including, but not limited to, those events listed above. We know that by signing this release that we are not waiving any liability of CBC for its intentional or reckless acts, but we are, on our own behalf and, to the extent allowable by law on behalf of our child, expressly waiving such claims for CBC's inadvertent or negligent acts. We realize and acknowledge that by engaging as a participant, there are risks and possible dangers to our child's health, life, and person when partaking of certain activities and events of the ministry, which risks can include, but are not limited to: broken bones, lacerated skin, sunburn, heat stroke, communicable illness, injuries from falling or flying objects, automobile accidents, other like calamities and even death. On behalf of our child, we understand the potential risks when participating in the activities that he/she will be called upon to engage in as a participant, and subject to the terms of this Parental Consent & Participation Release of Liability, we (on behalf of ourselves and, to the extent allowable by law, our child) unconditionally agree to hold CBC, its board, officers, staff, employees, volunteers or other agents harmless for any liability (except for intentional or reckless acts) concerning his/her life, personal health and well-being while participating in activities and events of the ministry. As a part of our release of claims, as mentioned above, we agree that at no time will we make a claim, file suit or otherwise initiate any legal proceedings against CBC for any of the claims for which we have released CBC arising from or related to the events mentioned in this release or our child's death, injury or damage arising from them.
In this digital age the church takes many pictures and videos of worship services, various ministries, special events and activities of the church. We use these media items to record, promote, and celebrate the ministry of our Calvary Bible Church through many different venues including, but not limited to: our church website, social media accounts, publications, and announcement videos at Worship Services. We request your permission to use your child’s picture in those ways. Names will not be used in conjunction with photos of minors. As parent/guardian, I give permission to Calvary Bible Church to include my child's image in any of the above mentioned ways for church and ministry purposes.