Consent and release form - MINOR


I, the undersigned, certify that I am the parent/legal guardian of _____________________________________

(hereafter the “minor child”).  I hereby give my consent to have my minor child participate in the following activity of Prairie Creek Baptist Church (hereafter PCBC), Mission Kidz Camp (hereafter “the activity”) on or about July 11 to 15, 2022. 

With full understanding of the risks involved and despite this Release, I am voluntarily consenting to allow my child to participate in this activity including riding in motor vehicles with representatives of PCBC.  My signature below acknowledges that I remain legally responsible for any of the minor child’s actions.  I hereby warrant that, to the best of my knowledge, the minor child is in good health.  I therefore agree to assume and take upon myself all the risks and responsibilities in any way associated with this activity. In consideration of and in return for services, facilities, and other assistance provided to me by PCBC, I release both PCBC and its representatives from all liability, claims, and actions that may arise from injury or harm to the minor child, from death or from damage to property in connection with this activity.  I understand that this Release covers liability, claims, and actions caused entirely or in part by acts or failures to act by PCBC, its agents, sponsors, and other participants, including but not limited to negligence, mistake, or failure to supervise.  I recognize that this Release means I am giving up, among other things, right to sue PCBC and its representatives for injuries, damages, or losses the minor child may incur while participating in this activity.  I also understand that this release binds my heirs, executors, administrators, and assigns, as well as myself. 

Consent for Emergency Medical Treatment of a Minor: In the event of an emergency, I hereby give permission to transport the minor child to a hospital or urgent care clinic or dentist office for emergency medical or surgical and or dental treatment.   I consent to any x-ray, anesthetic, medical, or surgical diagnosis or treatment and hospital care under the general or special supervision and upon advice of or to be rendered by a physician, dentist and surgeon licensed in accordance with Texas Family code Section 32.001.  I understand that every effort will be made to contact the emergency contact given.  If said contact cannot be reached, I hereby give permission to the physician selected by PCBC staff, representative or adult chaperone to hospitalize and secure proper treatment.   

Photography/Recording: I understand that pictures, videos, and audio recordings are taken at the activity.  I hereby give permission for the use of such pictures, videos, and audio recording of myself/the minor child for the promotion of Prairie Creek Baptist Church on social media accounts held by PCBC and their website, www.pcbcplano.org 

Banned Substances: I understand that there is zero tolerance for the use of illegal drugs or alcohol.  Any such use or possession is cause for immediate removal from the activity at which time arrangements will be made to send the participant home at my expense.

Firearms and Weapons: I understand that there is a zero tolerance for the possession and use of any firearm, explosive weapon, or knife.  The minor child may not bring to PCBC or any sponsored activity any weapons prohibited by law including but not limited to 1) guns, including air guns, paintball guns bb guns or stun guns  2) Knives of any size including pocketknives  3) fireworks of any kind, smoke or stink bombs or any other pyrotechnic devices  4) clubs or night sticks  5) Razors, box cutters, chains or any other object used in a way that threatens or inflicts bodily injury to another person 6) brass or metallic  knuckles 7) ammunition 8) mace or pepper spray.   Any such use or possession is cause for immediate removal from the activity at which time arrangements will be made to send the participant home at my expense.

I have read the entire release; I fully understand it and I agree to be legally bound by it. 

THIS IS A RELEASE OF YOUR RIGHTS.  READ CAREFULLY BEFORE SIGNING. 

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Printed name of parent/legal guardian                            Date Signed.

 

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Signature of parent/legal guardian