• Ridgedale Baptist Church Student Ministry 2017-2018

  • Before proceeding please read carefully:

    - We do require the upload of a photo of the students insurance card FRONT and BACK. If using a cell phone or tablet do this now before proceeding. ***If you are completing this for multiple students capture all of the medical cards in one photo for us (first photo front side of medical cards / second photo back side of medical cards)

    - Once you start completing the document keep going. It will not save your place or your information. You can navigate using ONLY the Back and Next buttons on the form. DO NOT use the back button on the browser. Doing so will erase your information.

  • Student #1 Information

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  • Student #2 Information

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  • Student #3 Information

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  • Parental / Guardian Information

    Mother or Guardian Information
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  • Parental / Guardian Information

    Father or Guardian Information
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  • Emergency Contact

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  • Medical Information

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  • Click on Choose File - We recommend going to your smart phone gallary to choose the photo of the Medical Cards.  (CAUTION)  Taking the photo while completing this form could reset the form causing you to start over. ***If you are completing this for multiple students capture all of the medical cards in one photo for us (first photo front side of medical cards / second photo back side of medical cards)  

  • Infromation Regarding Special Needs

  • Release Waiver

    August 1, 2017 to July 31, 2018
  • Consideration: I acknowledge the personal benefits accruing to me (and The Participant, as applicable) resulting from participation in church sponsored events and am aware of the activities in which I (or The Participant(s) applicable) will be involved in through said participation.

    Activity Release: I herby declare and affirm that I am the parent or legal guardian of The Participant identified on this form or that I am the adult (at least 18 years old) participant identified on this form (“The Participant”) and that my consent and permission for The Participant’s participation in Church sponsored events is legally sufficient and that no consent from any other person is required by law. I give my full and unqualified permission for The Participant to participate in all church-sponsored events during the current year August 1, 2017 to July 31, 2018 with the exception of the following: (Please list all events or activities from which you are withholding, limiting or otherwise qualifying your permission.)

    Release/Indemnification: I hereby, in consideration of such benefits and other good and valuable consideration received, consent to the above-indicated participation and release absolutely, forever discharge, hold harmless and covenant not to sue Ridgedale Baptist Church, its pastors, ministers, directors, officers, employees, agents, volunteers, and affiliates (Ridgedale Baptist Church LLC Knoxville, TN) from any and all present or future liability, claims, demands, actions, or rights of action, whether asserted by me or a third party arising out of participation in church sponsored events (the “Claims”). I agree to indemnify Ridgedale Baptist Church for any such claims brought by me or a third party from any costs associated with defending or litigating such claims, including but not limited to attorney fees, costs and legal expenses.

    Assumption of Risk: I am aware of the risks associated with participation in Church sponsored events and do hereby voluntarily assume full responsibility for any risk or loss, property damage or personal injury, including death, that may result from participation in such events.

    Appointment of Medical Authority: I herby appoint the Church or its designee as my attorney in fact and vest any of them with authority to authorize any necessary dental, medical or hospital care / treatment for The Participant. I further consent to any dental, medical or hospital care deemed necessary by a licensed physician and/or by the Church or its designee and agree to hold such persons and/or Ridgedale Baptist Church harmless from any claims, demands or suits for damages arising from such care and/or from consenting to such care.

    Acceptance of Medical Expenses: I agree to pay any and all medical expenses incurred in the care of The Participant. I hereby declare and affirm that my consent and agreement to pay any expenses resulting from any dental, medical or hospital care / treatment provided to The Participant is legally sufficient and that no consent from any other person is required by law.

    Media Release: I give my consent for the taking of photographs and/or video/audio recording of The Participant by Ridgedale Baptist Church and irrevocably waive and/or assign any and all rights (including copyright) in such media to Ridgedale Baptist Church. Ridgedale Baptist Church, as the sole owners of such media, shall have the exclusive right to control and determine the use, display, performance, reproduction and dissemination of any such photographs and/or video/audio recordings.

    Understanding:

    I represent and acknowledge that I have completely read and understand this document and all its terms and all matters refereed to herein and I signed voluntarily as my free act and deed, that I have had an ample opportunity to obtain the advice of legal counsel and that, by signing this document, I understand that I am relinquishing legal rights and remedies that may have otherwise been available to me. I understand that this Waiver and Release shall be construed as broadly and inclusively as permitted by applicable law and agree that if any portion of this document is held invalid, the remaining shall continue in full force and effect. To the extent the restriction on filing lawsuits is deemed unlawful, I agree to submit any Claims to a Christian conciliation/medication organization for binding resolution. It is understood and agree that copy of this form shall be treated as authentic and binding as the original.

  • CAUTION: READ THIS SECTION CAREFULLY BEFORE SIGNING.  THIS IS A GENERAL RELEASE AND INDEMNIFICATION OF CLAIMS.

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  • Thank You!

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