Activity ID:

Consent and Release Form for Church Activity

I, the undersigned parent or guardian*, consent to my child, ___________________________, who is _____ years of

age, participating in the activities connected with the _______________________________________________

to and from and at ______________________________, an activity sponsored by Heritage Baptist Church

I understand that my child will leave the church at approximately _________ and return at approximately __________, and that the transportation used will consist of Cars, Vans, Busses and any other appropriate means. I understand this activity may include: travel, stopping to eat, church services, sports events, sports activities, youth rallies, fellowships, work days, and any other event that is deemed necessary and proper by the church, it’s staff, and/or the activity director.

I certify my child is able to participate in all of these activities. If my child has medical conditions that may be

relevant to a physician in the event of an emergency, I have listed them below. If I cannot be reached within a reasonable

period of time, as determined by church officials, I authorize the church or the adult sponsor, to make emergency medical

decisions for my child. If there are activities that I do not want my child involved in, I have listed I have listed them below

I UNDERSTAND AND AGREE TO ASSUME ALL RISKS THAT MAY BE ENCOUNTERED ON ANY SAID ACTIVITIES, AS WELL AS ANY PRELIMINARY OR SUBSEQUENT ACTIVITIES.

I do, for myself and for my child, heirs and assigns, irrevocably and unconditionally release, acquit, and forever discharge

Heritage Baptist Church and its agents, employees, and volunteers from all liability, actions, causes of actions, claims,

expenses, obligations, and damages of any nature, including but not limited to injury to my child or property, even injury

resulting in death, that may arise in connection with my child's participation in the described activity or in any other

associated activities. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and

inclusive as permitted by the law of the State of Texas and that if any portion is held invalid, the balance shall continue

in full legal force and effect. This release contains the entire agreement between the parties.

I further state:

I HAVE CAREFULLY READ AND UNDERSTAND THIS RELEASE AND KNOW ITS CONTENTS,

THAT I SIGN IT AS MY OWN FREE ACT.

I understand this is a legally binding act.

Medical conditions to be aware of:

Physical restrictions:

Instructions and medications:

Date of last tetanus or booster (if known): ___________

I do not wish my child to participate in the following:

Parent or Gaurdian:____________________________________

Date:______________________

Telephone number(s) where I may be reached in an emergency:(_______)________________

*If you are an adult signing the release for yourself, please

Form provided by Christian Law Association

write your name in the blank where the child's name would be

written. Any reference to "child" will pertain to you.

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