FCBC Student Medical Release Form 2023-24

The undersigned is the parent or legal guardian of the Minor(s) named above (hereinafter referred to as “Minor(s)”).  The undersigned desires for said Minor(s) to attend and/or participate in ministries, events, programs, functions, and activities (hereinafter referred to as “Activity”), sponsored by, connected with, or related to Fruit Cove Baptist Church (hereinafter referred to as “Church”).

I understand and acknowledge that Church will not allow the Minor(s) to participate in any Church activity without releasing and holding the Church harmless from any liability arising out of the Minor(s) attendance and/or participation in that Activity, including the Minor(s) transportation to, during and from the Activity, if provided by the Church.

I have or will investigate all risks involved with the Minor(s) attendance and/or participation in any Activity, and further as the parent or legal guardian of said Minor(s) assume any and all risks of personal or bodily injury to said Minor(s) or property damages associated with said Activity.

I understand that as a participant, my child may be photographed or videotaped during normal camp or event activities and these photo/videos may be used in promotional materials (i.e. website, social media, etc.).

By signing this document, on behalf of myself and the Minor(s), I hereby release and forever discharge the Church, its pastors, officers, directors and employees, agents and any parties volunteering on behalf of the Church from all claims, damages, costs or expenses of any kind arising out of or related to the Minor(s) attendance or participation in any Church Activity.  I understand that this document is a full complete release of all claims for personal or bodily injury and property damage which the Minor(s) might sustain as the results of the Minor(s) attendance and/or participation in any Church Activity, regardless of the specific cause thereof, and I further understand that in the event of such personal or bodily injury to the Minor(s), or property damage, that I cannot seek, on behalf of the Minor(s) or myself, any type of recovery or reimbursement whatsoever from the Church or their pastors, officers, directors, employees, agents or any parties volunteering on behalf of the Church.





Parent/Guardian Information

Parent/Insurance Information

In Case of Emergency

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.