2025/26 Student Ministry Release Form

June 2024-May 2025 Ministry Year

Your name *

Email address *

STUDENT INFORMATION:

Student Name *

Grade *

Gender *

Birthday *

Address *

Best form of contact (Student): *

We love having our small group leaders reach out and check in on our students. Please let us know the best way to get a hold of them. If they don't have any technology please write "N/A"

Medical Conditions + Medications: *

Please list any and all medical conditions (including allergies), and medications taken for each condition if any. If student has no medical conditions and takes no medications, please write "N/A."

Dietary Issues :

Please list any special notes about your student's dietary needs below.

T-Shirt Size

PARENT INFORMATION

Parent / Guardian #1 Name: *

Phone Number: *

Email: *

Parent / Guardian #2 Name:

Phone Number:

Email:

WAIVER

Berkley Student Ministry 2024-2025 Release Form

Consideration: I am aware of the activities which my child will be involved in while participating in Berkley Hills Student Ministry from June 1, 2024-May 31, 2025.

I hereby, in consideration of such benefits and other good and valuable consideration received, consent to the above listed participation and release absolutely, forever discharge, hold harmless and covenant not to sue Berkley Hills Church, the grounds it is located, its directors, employees, volunteers, and affiliates 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 my child's participation in the event activities. I agree to indemnify and hold harmless Berkley Hills 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 the above events and do hereby voluntarily assume full responsibility for any risk of loss, property damage or personal injury, including death, that may result from participation in event activities.

Medical Emergency: In the event of an injury or medical emergency, I understand that Berkley Hills employees and or volunteers will be responsible for the medical care of all attendees. It will be their responsibility to assess medical needs, obtain and consent to appropriate medical care, transport persons in need of medical care and contact parents or guardians or minors. I release Berkley Hills Church from any and all liability related to medical treatment. In addition, I assume the risk and financial responsibility for any injury resulting from the attendee's participation in all ministry events.

Understanding: I represent and acknowledge that I have completely read and understand this document and all its terms and all matters referred to herein, and I signed voluntarily as my free act and deed, that I have had ample opportunity to obtain the advice of 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 is 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 mediation organization for binding resolution.

Media Consent: I give my consent and permission for the taking of photographs and/or video of my child during the described events.

Digital Signature: *

Parents + Guardians: Please type name below indicating that you have read our Student Ministry Waiver and agree to the terms.

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