To Whom It May Concern:

The undersigned does hereby give permission for my child(ren) listed on the front of this form, to attend and participate in ALL activities sponsored by CENTRAL BAPTIST CHURCH and/or KID CENTRAL MINISTRIES

for January 1, 2022 through December 31, 2022

Liability Release: In considerations of Central Baptist Church allowing the participant to participate in children activities, I, the undersigned, do hereby release, forever discharge and agree to hold harmless Central Baptist Church, its pastors, employees, and volunteers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the children activities. I the parent or the legal guardian of this participant hereby grant my permission for the participant to participate fully in children activities, including trips away from the church premises. Furthermore, I, on behalf of my minor participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify said church for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.

We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray

examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under general or special supervision and on the advice of any physician or dentist licensed under the provision of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to the authorization.

Should it be necessary for our (my) child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs.

The undersigned does also hereby give permission for our (my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by CENTRAL BAPTIST CHURCH and/or KID CENTRAL MINISTRIES.

I consent to the use of my child’s image or voice in photographs, audio and/or video recordings taken during the course of the event for the purpose of promoting CENTRAL BAPTIST CHURCH and/or KID CENTRAL MINISTRIES. 

Insurance?  _____ Yes  _____ No

Insurance Company ____________________________________________________________________

Policy Number ________________________________________________________________
 

Parent/Guardian Signature: _____________________________________________________         Date: ______________________ 


If you wish to download and print this form, please click the following:  Parent_Consent_and_Liability_form_for_Kid_Central_2022.pdf