Ignite Youth Permission Form

Child's Name*

First NameLast Name

Parent/Guardian Name:*

First NameLast Name

Parent/Guardian Phone Number*

Area CodePhone Number

Parent/Guardian Email*

example@example.com

I am the child's:*

ParentGuardian

I, {yourName}, the parent or legal guardian of, {childsName}, grant Ignite MBC Student Ministries the following permissions:

PHOTO PERMISSION: I grant my permission to use any photos, taken at youth functions, on their website or social media pages.*

YesNo

MEDICAL TREATMENT PERMISSION: I authorize any leader of Ignite MBC Student Ministries, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental 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 dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.*

YesNo

TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for my child/youth to ride in any vehicle driven by an approved and licensed ADULT chaperone while attending and participating in activities sponsored by Ignite MBC Student Ministries. My child/youth and I understand that it is my child’s responsibility to remain buckled at all times.*

YesNo

LIABILITY WAIVER: In consideration of Monument Bible Church allowing the Participant to participate in youth ministry (Sunday worship, Sunday meeting, Activities, Events, Retreats, Lock-Ins, Trips) I, the undersigned, do hereby release, forever discharge and agree to hold harmless Monument Bible Church, its pastors, leaders, employees, volunteers from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the children/youth activities and childcare. I the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate fully in children/youth ministry activities and child care, including trips away from the church premises.

I have read and agree to the terms and conditions stated above.

Please sign: _________________________________________

Please print name: ___________________________________

Please sign below:*

Type your signature here:*