My student may be attending various events with First Baptist Cushing (FBC). I may or may not be attending events with my student. In the event that my student should need emergency medical attention, FBC and/or any one of its agents or employees is hereby authorized to provide such emergency medical care, including without limitation; medical, dental, surgical care or hospitalization, to my student as recommended or suggested by a physician, nurse, surgeon, or other healthcare professional. I understand that in the event I cannot be reached in an emergency, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment, or order an injection, anesthesia, or surgery for my child as deemed necessary.

If such emergency care is provided, I understand that my student's health insurance and healthcare information will be provided to the healthcare professional and healthcare institution providing care for my student. I further understand that any expense not covered by my student's medical insurance shall be my responsibility. I understand that FBC, will not be obligated to pay either the healthcare professional or me for any medical expenses incurred on behalf of my student.

There are instances when third party contractors may be used to operate and supervise various events and activities. In those instances where third party contractors are used, FBC, is not responsible for the action of these third party contractors. FBC is also not liable for the actions or activities of participants or sponsors participating in events or activities operated by third party contractors.

I understand all reasonable safety precautions will be taken at all times by FBC and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. In consideration of my student being allowed to attend activities with or at FBC, I, on behalf of my student, hereby waive any and all causes of action, rights of claims or suits which I or my child may have against FBC, its agents, contractors or employees as a result of injury to my student or arising from the decision of FBC, or its agents, contractors or employees to consent for provision of emergency medical care to my student.

I hereby give my permission to have my minor child participate in First Baptist Student Ministry activities.


I recognize that there are risks involved in participating in these activities and hereby assume all risk of injury, harm, damage, or death to my minor child in connection with his/her participation in this activity.

Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19.  While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases.

If, however, your child observes any unusual or significant hazard during their presence or participation, they should remove themselves from participation and bring such to the attention of the nearest official immediately.
I understand that the novel coronavirus causes the disease known as COVID-19.

I understand the novel coronavirus has a long incubation period during which the carriers of the virus may not show the symptoms and may still be contagious.
I understand that:
- Physical distancing of 6 feet may not be possible at all times.
- Minor child must make all attempts to cover his/her mouth/nose in the event of coughing and/or sneezing and then immediately sanitize his/her hands.

I confirm that:
My minor child is not currently positive for COVID-19
My minor child is not waiting for the results of a laboratory test for COVID-19.
My minor child has not been identified as being in contact with someone who has tested positive for COVID-19, or been asked to self-isolate by any government agency.
My minor child is not in high risk category for increased illness or death from COVID-19, including: diabetes, cardiovascular disease, hypertension, lung disease including moderate to severe asthma, being immunocompromised (including transplant recipient), having active malignancy.

My minor child is NOT presenting with any of the following symptoms of COVID-19:
Fever over 100.4
Chills or body aches
Cough
Sore throat
Shortness of breath/Difficulty breathing
Flu-like symptoms
Non-allergy related runny nose
Loss of smell or taste

I will immediately notify First Baptist Cushing if myself or my minor child contracts the virus before the event.

To the fullest extent permitted by law, I release First Baptist Cushing, its trustees, officers, directors, employees, agents and representatives from any injury, harm damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless First Baptist Cushing, its trustees, officers, directors, employees, agents and representatives from any claims arising out of my minor child’s participation in the activity.

Further, being the parent or legal guardian of the minor child, I do consent to any medical, surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for my minor child.  I understand that efforts will be made to contact me prior to treatment, but in the event I cannot be reached in an emergency, I give permission to First Baptist Cushing’s staff & volunteers to make the decisions necessary for treatment.  Should there be no activity leader available, I give permission to the attending physician to treat my minor child.  As parent or legal guardian, I understand that I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for the medical, dental, or hospital care or treatment that is given to my minor child.  Any insurance policy of the church or organization sponsoring this event will be used as the secondary coverage.

By signing below, I verify that the information I have provided on this form is truthful and accurate. I have read and explained the provisions in this waiver/release to my minor child including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases.  Furthermore, my minor child understands and accepts these risks and responsibilities.  I for myself, my spouse, and minor child do consent and agree to his/her release provided about for the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s presence or participation in these activities as provided about, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.


I understand that my student may be included in video highlights and/or photographs during the course of the year and that said pictures and videos may be used for promotion of FBC events and/or posted on FBC website and/or other social media pages.

I give authority and permission to FBC, staff and its agents to inspect my student's belongings while on activities, retreats or camps for the safety of my student, other students, staff and agents of FBC and all other participants.

Should it be necessary for my student to return home due to medical reasons, disciplinary action, or otherwise, I assume all transportation arrangements & costs.

By typing your name below, you are acknowledging and agreeing to the above release.