2022 -2023 Waiver

Email*

example@example.com

I, (parent/ legal guardian)

Parent/ Legal Guardian Name*

First NameLast Name

hereby grant consent for

Child's Name*

First NameLast Name

Child's Name

First NameLast Name

Child's Name

First NameLast Name

Child's Name

First NameLast Name

to attend trips and other scheduled supervised on site and off-site program activities as part of Colonial Hills Baptist Church's programs.

I understand that the trips and activities will be to various venues from June 2022-June 2023.

I understand that supervision will be provided by Colonial Hills Baptist Church's staff and/or volunteers.

I further grant consent for Colonial Hills Baptist Church to arrange to transport the above named child in agency approved transport or by any commercial carrier to all field trips and scheduled off site program activities.

By signing this consent, I agree to hold Colonial Hills Baptist Church and its agents, staff, employees, officers and trustees harmless from any liability or claim arising out of, or related to, the above named child’s participation in the program and activities.

In the event of a medical emergency, if the staff of Colonial Hills Baptist Church is unable to reach me or the emergency contact listed below, I hereby give consent for Colonial Hills Baptist Church to seek, authorize and obtain medical treatment for the above named child.

Statement of Waiver of Liability and Assumption of Risk
Related to Coronavirus/COVID-19

COVID-19 is highly contagious and is known to spread mainly from person-to-person contact. By attending the ministries of Colonial Hills Baptist Church, you agree to voluntarily assume the risk that you and/or your family may be exposed to or infected by COVID-19 either at the church, in the church worship service, or in the nursery or Sunday School. You agree to assume all the risks of attendance and participation for you and your family, and you waive any liability against the church and any other parties.

Emergency Contact Name:*

First NameLast Name

Emergency Contact Phone Number:*

Area CodePhone Number

Family Physician Name:

Family Physician

Family Physician Phone Number:

Area CodePhone Number

By providing your signature below, you will be providing your electronic signature.

Parent/ Guardian Signature:*

Clear

Date*

Date

Child's Name:*

First NameLast Name

Child's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code