• Alaska Baptist Church Youth Group
    2019/2020 Youth Group Parent Permission/Medical Form

    This permission & medical form gives the student named below permission to participate in the Alaska Baptist Student Ministry events from Sept 1st, 2018 - August 31, 2019.   If you have any questions, please feel free to contact us at office@alaskabaptist.org
  • Student Information

  • Parent/Guardian Information

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  • Emergency Information

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  • Medical Information

    If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury while your youth is at the event.

  • Informed Consent and Acknowledgement

    I hereby give my approval for my child’s participation in any and all activities of Alaska Baptist Church during the selected session. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Alaska Baptist Church and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of travel to, participating in, or returning from service projects, events, concerts, conducted during the season.

    I hereby acknowledge that if my child has to return home early for disciplinary actions, it will be at the expense of the parent/guardian.

    In case of injury to said child, I hereby waive all claims against Alaska Baptist Church including all leaders and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

    Furthermore, all images and videos of Alaska Baptist Church Youth Group are the property of Alaska Baptist Church and can be used for any promotional consideration.

    I hereby state that I have carefully read the above waiver. Acceptance and understanding of this agreement are hereby acknowledged.

  • I have read and agree to the Informed Consent and Acknowledgement.

  • Medical Release and Authorization

    As Parent and/or Guardian of the named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

    Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named child. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

    Permission is also granted to the Alaska Baptist Church Director/Leader/Team Parent to provide the needed emergency treatment prior to the child’s admission to the medical facility.

    Release authorized on the dates of the registered sessions.

    This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

  • I have read and agree to the Medical Release and Authorization.

  • Confirmation

  • By entering the information below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.

  • After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at office@alaskabaptist.org

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