2025 – 2026 Kid’s Ministry Permission and Health Release Form

The following form will be used for any kid’s ministry activity that requires a health release form for one year from the date submitted.

Child Information

Name *

First

Middle

Last

Date of Birth *

Gender *

Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

Grade in School *

Parent/Guardian Information

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Father's Name *

First

Last

Father's Email *

Father's Mobile Phone *

Mother's Name *

First

Last

Mother's Email *

Mother's Mobile Phone *

Does the child and the parent(s) live at the same address listed above? *

Primary Emergency Contact

In addition to the parents listed above

Name *

First

Last

Relationship to Child *

Phone *

Additional Emergency Contacts

Name *

First

Last

Relationship to Child *

Phone *

Name *

First

Last

Relationship to Child *

Phone *

Acknowledgements

I, the undersigned, do hereby verify that the above information is correct and accept all responsibility to notify and submit an updated release to Memorial Baptist Church if any of the information changes.

I, the undersigned, accept financial responsibility for the well-being of the above-named person and hereby authorize Memorial Baptist Church, their employees, associates, or volunteers in charge to obtain medical attention in the case of sickness or injury. I also authorize the attending physician or dentist to provide any and all required medical treatment.

I, the undersigned, do release and forever discharge all sponsors, Memorial Baptist Church, their employees, associates, and volunteers from any claim, demands, actions or cause of action, past, present, or future arising out of any damage, injury, loss of property or death while participating in Memorial Baptist Church ministries.

I, the undersigned, grant permission for the above to participate in all the recreational activities for the year with Memorial Baptist Church. I understand some recreational activities involve a certain degree of risk that could result in injury or death. I have carefully considered the risk involved and agree to release Memorial Baptist Church, their employees, associates, and volunteers from any and all liability which could result from participating in these recreational activities.

I, the undersigned, grant permission and release Memorial Baptist Church, their employees, associates, and volunteers from any and all liability when transporting the named person above to and from these events.

I, the undersigned, understand that as a participant my child may be photographed or video taped during normal Memorial Baptist Church ministry activities and I hereby grant permission for those photos/videos to be used by Memorial Baptist Church.

I, the undersigned, accept that a copy of this form is as valid as the original.

Child's Name *

Parent/Guardian *

Parent/Guardian Signature *

Clear Signature

Date *

Note from Next Gen Pastor and Children's Minister

Please initial the following statements

I understand as a parent that it is my duty to make myself aware of any event that my child is taking part in. I will use foresight when deciding what events my child is able to take part in. I understand that dropping my child off, or someone else dropping them off at an event means that he/she has my permission to take part in that event. I understand I have multiple ways (phone call, text, email, or in person) to ask absolutely any question about anything my child will be taking part in. I also understand that it is impossible for leaders of Memorial Baptist Church, their employees, associates, or volunteers to keep an eye on my child at all times and it is my responsibility to make sure my child understands that they are to conduct themselves in a responsible manner and obey the rules they are given. I understand that when my child attends any event that they are obligated to stay with the group and not allowed to do whatever they want but must comply with what the group is doing. I will also not hold Memorial Baptist Church, their employees, associates, or volunteers responsible if my child makes an unforeseen bad decision that may result in death or injury. I will not hold Memorial Baptist Church, their employees, associates, or volunteers responsible for any injury that occurs to my child when safety equipment is provided or suggested and rejected by my child (i.e. Seatbelt or lifejacket). Finally, I am giving my child permission to swim in waters that are not protected by lifeguards. I understand that I am responsible for sending any and all safety equipment that my child needs for swimming and it is my parental responsibility to make sure my child uses and knows how to operate such device. *

As parent/legal guardian of the child named above, I will review information about any kids ministry activity/event that my child attends and I give my permission for him/her to be involved in the activity. I also authorize this permission form to be valid for one full year from the date signed. *

As parent/legal guardian of the student named above, my child is aware of the stipulations above and agrees to abide by them. If my child fails to do so, I understand and agree that at my own expense I will travel to and pick up my child from any event in a timely manner at the request of Memorial Baptist Church, their employees, associates, or volunteers. *

2025 – 2026 Kid’s Ministry Permission and Health Release Form

Child Information

Parent/Guardian Information

Primary Emergency Contact

Additional Emergency Contacts

Medical Information

Health History

Acknowledgements

Note from Next Gen Pastor and Children's Minister