Consent and Certification
I, the undersigned, being the parent or legal guardian of the youth named below, do hereby consent to the participation of my youth in all the scheduled youth activities of Westwood Baptist Church, and any other supervised activities customarily associated with its youth ministry, including weekly youth events, overnight and weekend youth trips. Further, I certify that my youth is physically fit and adequately prepared to participate in all recreational and sporting events. I also understand that my youth’s picture and/or video could be used in social media or other online formats in a public manner. If I wish to revoke this consent for any reason, I will promptly notify the ministry leader in writing.
Medical Treatment Authorization
I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached I authorize calling the emergency contact and the calling of a doctor. These persons, including the Youth Pastor and adult chaperones, can authorize the providing of necessary medical services in the event that my youth is injured or becomes ill. If the parent or guardian cannot be reached, I authorize the emergency contact (listed above) and/or doctor to make medical care decisions on behalf of my youth, if required by law or a health care provider. I authorize these persons to act in my place to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, and hospital care.
I understand that the person(s) making such medical decisions for my youth will not be responsible for medical expenses incurred solely on the basis of this authorization. I further agree to notify the Youth Pastor in writing of any health changes that would restrict my youth’s participation in any normal youth activities. I also understand that the Youth Pastor and designated adult chaperones reserve the right to restrict my youth from any activity that they do not feel is within the physical capabilities of my youth.
In consideration of being permitted to use the facilities at Westwood Baptist Church,
4001 Georgetown Rd NW, Cleveland, TN (the “Property”),
I hereby execute this Release and Waiver of Liability (“Release”) and assume full and complete responsibility for any injury, accident, illness, medical expenses or loss of property that may occur while I am on the Property and relinquish any and all rights I have now or may have in the future against Westwood Baptist Church, its employees, members, or agents (collectively, the “Church”), arising out of or related to my utilization of the Property.
I do hereby, voluntarily and without duress, execute this Release under the following terms:
1. I do hereby waive, covenant not to sue, release and forever discharge, indemnify and hold harmless the Church from any kind of liability, claims, fines, suits, orders, actions, damages, costs and/or expenses and demands of whatever kind or nature, either in law or in equity, that I may have against the Church arising out of or in any way connected with or related to my presence at or participation in activities arising from the utilization of the Property. I understand that this Release discharges from the Church from any and all liability or claims that I may have against the Church with respect to any bodily injury, personal injury, illness, medical expenses, death, property damages or consequential expenses or losses that may result from my utilization of the Property, whether caused by the negligence, the action or inaction of the Church.
2. I am aware of and expressly and specifically assume all risks associated with my participation in the activities of the Property.
3. I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Tennessee, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Tennessee. I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
4. I execute this Release for full, adequate and complete consideration fully intended to be bound by the same.
5. I, understand that my child(ren) whose names are listed above may be photographed at any Westwood event. I understand that these photographs may be used in promoting our church, either in print or on the internet. I also understand that it is my responsibility to update this form if I no longer wish to authorize photos being used. If you do NOT wish for your child to be used in photos for the promotion of Westwood Baptist Church, you must provide the ministry leader a written notice by letter or email.
I further understand that if I am a minor, this Release and Waiver must be signed by a parent or guardian. If I am the parent or guardian of the minor, I understand that by signing this Waiver of Liability I, and the minor whose behalf I am signing, are bound by its terms.
If signing on behalf of an entity or group, I represent that I am duly authorized to execute this Release on behalf of the entity or group I represent.
