Youth Form

    If you would rather print out and fill out a paper copy:


    Release of All Claims
    In consideration for being accepted by Edgemoor Baptist Church (the Church) for participation in Youth Activities for the calendar year of 2017 within the United States we, (I), being 21 years of age or older, do for ourselves (myself) and for and on behalf of my child-participant if said child is not 21 years of age or older, hereby release, forever discharge and agree to hold harmless Edgemoor Baptist Church and the directors, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above described trip or activity.
    I (We) hereby agree as follows:
    1. I assume full legal and financial responsibility for my participation in the activity.
    2. I grant the Church, its employees, agents, and representatives the authority to act in any attempt to safeguard and preserve my health or safety during my participation in the field trip/activity including authorizing medical treatment on my behalf and at my expense and returning me home at my own expense for medical treatment or in case of an emergency.
    3. Accident and health insurance are recommended for my participation in this field trip/activity. I understand that Edgemoor encourages me to have appropriate insurance coverage for the entire time of the field trip/activity.
    4. I shall conform to all applicable policies, rules, regulations, and standards of conduct as established by the Church to ensure the best interest, comfort, and welfare of the trip.
    5. I voluntarily indemnify and hold harmless the Church, Board, Employees, and volunteers, their respective officers, and agents from any and all liability, loss, personal injury, sickness or death, as well as property damages, costs, or expenses, of any nature (including attorney’s fees) whatsoever arising out of my participation in the field trip/activity and which include any negligent acts or omission of an officer, employee, and agent of the Church, Board employees, and volunteers, while acting within the scope of their employment or duties for the Church.
    6. I acknowledge that I have read this document and understand and accept its terms.

    For more information on the legality of digital signatures, please visit Tenn. Code Ann. § 47-10-107.

    Participant's Name
    Parent's Name

    Parent(s) phone
    Emergency phone

    Today's Date
    Legal Guardian Name

    Participant Signature (use mouse or finger):
    Parent Signature (use mouse or finger):

    Parent Medical and Liability Release Statement

    Edgemoor Baptist Church

    I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I cannot be reached in an emergency during the activity dates shown on this form, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed. I understand all reasonable safety precautions will be taken at all times by Edgemoor Baptist Church and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Edgemoor Baptist Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.
    Parent Signature (use mouse or finger):
    Student's Signature if over 18 years old:

    Parent Typed Name:
    Today's Date: