2020 First Students Parental Consent Form
First Baptist Church of Bushnell
Student's Full Name *
Student's Birthday *
Gender *
Grade *
Physical Address *
Mailing Address (if different)
Father's (Guardian's) Name *
Father's (Guardian's) Phone Number
Mother's (Guardian's) Name & Phone Number *
Mother's (Guardian's) Phone Number
Parent's Email Address *
Would You Like to Be added to Our Parent's Email List?
Please Read Carefully
Permission: The undersigned does hereby give permission to my (our) child to attend and participate in activities sponsored by First Baptist Church Bushnell. Also for pictures taken at events and activities to be used by the church on social media and possibly promotion materials.

Release: The undersigned does hereby release First Baptist Church Bushnell and all associated parties including cooperating churches and trained personnel of liability in the case of injury to any participants in the programs provided by First Baptist Church Bushnell. First Baptist Church Bushnell cannot and should not be held responsible for a minor’s conduct that violates rules established by First Baptist Church Bushnell to protect him/her from harm or injury. Should my (our) minor child violate any of First Baptist Church Bushnell rules, policies, or procedures or behave in a manner inconsistent with First Baptist Church Bushnell's mission and philosophy while participating in the First Baptist Church Bushnell sponsored event, I (we) Acknowledge that said minor child may be sent home at my (our) expense.

Medical Authorization: Should my (our) minor child become ill or injured during a First Baptist Church Bushnell sponsored event, I (we) authorize the group of leader(s)/authorized personnel, in whose care the minor has been entrusted, to rely on the advice of licensed medical physician(s) and/or dentist(s), and in reliance on the medical/dental judgment to consent to any and all necessary medical and/or dental treatment, which may include x-rays, diagnostic/radiological tests, administration of medications and/or anesthesia, surgical intervention, and/or hospitalization. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in the connection with such authorization. Should it be necessary for my (our) child to be transported by an authorized emergency medical vehicle due to medical reasons or otherwise, the undersigned shall assume all costs and expenses related to such transportation and related emergency medical treatment.

This release form will serve as a blanket for all student ministry activities for the year of 2020. Please make First Baptist Church Bushnell aware of any changes in your health insurance or emergency contacts.
Signature Of Parent Or Guardian (By Typing Name You Are Signing For Release) *
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