Consent and Certification
I, the undersigned, being a parent or legal guardian of the student named above, do hereby consent to the participation of my
student in all the scheduled activities of Arbuckle Community Church, and any other supervised activities customarily associated
with its Arbuckle Youth or Arbuckle Kids, including youth group and overnight or weekend youth trips. Further, I certify that
my student, unless noted above, is physically fit and adequately prepared to participate in all recreational and sporting events, unless noted in the medical section. If I wish to revoke this consent for any reason, I will promptly notify a church leader in writing.
Medical Treatment Authorization and Release of Liability
This consent form gives permission to seek whatever medical attention is deemed necessary and releases the Church and its staff of any
liability against personal losses of named student.
I/We have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized
by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the
Church, its pastors, employees, agents, and volunteer workers from all liability for any injury, loss, or damage to person or property that
may occur during my/our child’s involvement. If he/she is injured and requires the attention of a doctor, I/we consent to any reasonable
medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital
personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages
arising from the giving of such consent.
I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not
be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at
this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child
home at my/our own expense should they become ill or if deemed necessary by a family ministries staff member.