Permission Slip & Medical Waiver
INSTRUCTIONS: If you are under 18 years of age, your parent or guardian must complete this section. If you are 18 years of age or older, you can complete this form for yourself.
Permission Slip for Any Church Related Function and Consent for Medical Treatment for Minors
The undersigned hereby gives permission for the above student to attend the HSM Winter Camp event with Bethany Bible Church. In the event there is an emergency involving my child, permission is hereby granted for Bethany Bible Church personnel to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care to be rendered to the minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice in any state, and to consent to any x-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to the minor by any dentist licensed to practice in any state, and church personnel shall not be held personally liable.
(Typing my name in the space below serves as my digital signature.)
Please provide the following information:
*Please fill out this waiver in addition to the other information you are providing to BBC*
Young Life asks that each camper fills out their own Release Form prior to attending camp. This form must be printed, completed, and given to Matt Burkholder prior to our departure from BBC on January 17, 2020.
Download the Release Form PDF here.
Photography and Video Release for Minor Registrants
I acknowledge Bethany Bible Church and its representatives may take photographs and/or video of the minor who is being registered for this event and used by Bethany Bible Church for promotional needs, both in print and on the web. I know that in order to opt out I must contact Kellie Griffin at Bethany Bible Church at (602) 246-9788 or email@example.com with my opt-out request. I have full authority to authorize this release.
Registration Payment Total