Bus Ministry Permission - Liberty Baptist

Liberty Baptist Bus Ministry Permission Form

Transportation To and From Church
Please fill out the form below to register to ride on the bus ministry at Liberty Baptist Church Please be sure to list any medical conditions or allergies.

Contact Information
Clay Carrigan | Youth Pastor 615.438.7769

Parent's Name

Child's Name

Email Address

Medical Conditions / Allergies

Phone / Emergency Contact

Child's Birthday

Address

Additional Comments

By checking this box, the parent / guardian hereby gives consent for my child to participate in the event described above. I certify that my child is able to participate in this event. If my child has medical conditions that may be relevant to a Physician in the event of emergency, I have listed them above. In the event an emergency occurs, I may be reached at the telephone number listed below. If I cannot be reached, I hereby authorize any agent of Liberty Baptist Church to make emergency decisions for my child. If there are any activities in which I do not want my child to be involved they have been stated in writing on this form. I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITY, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby agree to hold Liberty Baptist Church and its agents and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of Tennessee and that if any portion thereof is held invalid, it is agreed that the balance shall; notwithstanding, continue in full legal force and effect. This release contains the entire agreement between parties here to and the terms of this release are contractual and not mere recital. I further state that I HAVE CAREFULLY READ THIS FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legal binding agreement, which I have read and understand.

Success...Your child is signed up

Your message has been sent successfully, See you @ VBS!