B3Students Medical Release & Liability Waiver
The completion of this form is required for all students who are participating in Arran Lake Baptist Church Student Ministry events for the ministry year, September 1, 2020 - August 31, 2021
Student Full Legal Name *
Address *
Student Phone (if available)
Parent/ Guardian Full Name *
Parent/ Guardian Cell *
Parent/ Guardian Email: *
Insurance Company *
Insurance Policy Number
Student Primary Care Name
Student Primary Care Phone Number
Please list any current or previous medical problems or allergies we should be aware of. If your student does not have any known medical problems or allergies, please indicate by typing "none". *
Please list any medications (prescription & non-prescription) your teenager is currently taking and proper dosage. If your student does not take medication, please indicate by typing "none". *
Date of last tetanus shot. If unavailable, indicate that it is up-to-date
Describe your student's ability with regard to swimming. *
Please list any physical conditions we should know about concerning your student. *
I hereby grant permission for my teenager to participate in all B3Students activities, including Sunday morning, Sunday night, Summer, and any other activity approved by B3Students and its leaders. *
Required
I grant permission for any medical assistance deemed necessary by qualified medical personnel to be conducted on my teenager should an emergency arise and I am unable to be contacted. *
Required
I release Arran Lake Baptist Church of Fayetteville, NC, it’s pastor, staff & chaperons from the liability of any accidents which may occur. *
Required
Arran Lake Baptist Church and B3Students want to make sure that we are transporting your student(s) in the safest possible manner. As we travel to different functions, it is not always possible to drive rented vans. Sometimes, we have leaders drive and sometimes we have students drive themselves or ride with other students if they are able. Please indicate below your desired option for transporting your student(s). *
Required
On March 11, 2020, the World Health Organization declared the novel coronavirus, COVID-19, a pandemic. COVID-19 is highly contagious and known to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people over the past several weeks. By attending Arran Lake Baptist Church as well as B3Student events, you acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you and your family may be exposed to or infected by COVID-19. You also acknowledge that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of yourself and/or others, including, but not limited to, Arran Lake Baptist Church Staff, volunteers, members, and participants and their families. You agree to assume all the foregoing risks, waive liability against Arran Lake Baptist Church, B3Students, and any other listed parties, and accept sole responsibility for any illness, injury, disability, or death to you or your family, including all claims that may arise resulting from any of these. *
Required
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