Events and Activities Parental Consent and Release Form

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Student's Events and Activities Parental Consent and Release Form

"*" indicates required fields

Parties

This Release from Liability ("Release") is made on 04/04/2026, by and between Liberty Baptist Church ("Church") and Parent/Guardian on behalf of his/her minor Student.

Parent Full Name*

("Parent/Guardian")

Student Full Name*

("Student")

Personal Information

Student's Age*

Student's Grade*

Student's Date of Birth*

Month

Day

Year

Home Campus*

Address*

Street Address City State ZIP Code

Event and Activities

Liberty Baptist Church will be conducting the following Event.

Event

Consideration

In consideration of participation in the above-listed event, Parent/Guardian does hereby grant this Release of Liability and grant permission for Student's participation.

Medical Information

Is sponsor authorized to obtain medical treatment?*

Yes

No

Is participation covered by personal/family medical insurance?*

Yes

No

If Yes, Name of Insurer*

Policy/Group #*

Allergies

Surgeries

Medications

Does your Student suffer from

Asthma

Anxiety

Diabetes

Physical Handicap

Epilepsy/Seizure Disorder

Heart Trouble

Stomach Issues

Other

Other*

Emergency Information

Primary Care Physician

Primary Care Phone

Primary Contact

Relationship

Phone

Secondary Contact

Relationship

Phone

Students are expected to conform to the following code of conduct:

No possession, influence, or use of alcohol, drugs, or tobacco
No students may drive during youth activities
No fighting, weapons, fireworks, lighters, or explosives
No boys in the girls sleeping quarters and no girls in the boys sleeping quarters
Participation with the group is expected
Respect property of others
Respect one another, staff, and volunteer leaders
Respect and comply with the event schedules, rules, and instructions

Failure to comply with the Code of Conduct may result in the Student being sent home at the Parent's Expense.

Consent, Release, Student Agreement, and Indemnification

Parent/Guardian consents to the participation of Student in the above listed Event and Activities.
Parent/Guardian certifies that Student is physically and emotionally able to participate in the above listed Event and Activities.
Parent/Guardian certifies that he/she executes this release freely, voluntarily, and after sufficient review.
Parent/Guardian certifies and he/she has the authority to release Church from any and all claims and has not transferred such authority to any other person.
Parent/Guardian and Student acknowledge that there are inherent risks involved the Event and Activities listed above.
Parent/Guardian authorizes the agents of Church to make emergency medical decisions on behalf of Student in the event Parent/Guardian cannot be reached. Parent/Guardian acknowledges that he/she will ultimately be responsible for the cost of any medical care provided to Student.
Parent/Guardian agrees to release and indemnify the Church, its pastors, trustees, officers, directors, employees, agents, and volunteer workers from any and all liability for injury, loss, or damage to person or property that may occur during the course of the Student's involvement in the Event.
Student acknowledges that he/she has read the rules of conduct above and agrees to abide by the code of conduct at risk of being sent home at his/her parent's expense.
This Release does not extend to claims of intentional acts, gross negligence, or willful or wanton conduct arising from Student's participation in above listed Event and Activities. Parent/Guardian agrees to attempt to settle all such claims through good faith negotiation with Church. If good faith negotiation fails, Parent/Guardian agrees to attempt to settle all such claims through mediation with a professional mediator. If mediation fails, Parent/Guardian agrees to that the laws of the Commonwealth of Virginia shall govern and the jurisdictional forum shall be the Commonwealth of Virginia.

Parent/Guardian Signature*

Today's Date*

Student Signature*

Today's Date*

Name of Parent/Guardian*

Relationship to Student*

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Locations

Fairview Heights
The Chapel
Gloucester
Greenbrier
Hampton
Harbour View
Smithfield
York River

Get Connected

Next Steps
Prayer
Events
Groups
Baptism
Senior Adults
Leadership Institute

Leave a Legacy

Serve
Local Missions
Global Missions
2414 Discipleship
School of Ministry
Job Opportunities
Legacy Team

Next Generation

Kids
Students
Young Adults
Parent Resources

Quick Links

Online Store
Media Kit
Event Request
Food Services
Library
Childcare Reimbursement
Privacy Policy

Watch
Messages
Give
Life Track
Liberty Live Worship
Member Portal (My.LibertyLive.Church)

Fairview Heights
The Chapel
Gloucester
Greenbrier
Hampton
Harbour View
Smithfield
York River

Next Steps
Prayer
Events
Groups
Baptism
Senior Adults
Leadership Institute

Serve
Local Missions
Global Missions
2414 Discipleship
School of Ministry
Job Opportunities
Legacy Team

Kids
Students
Young Adults
Parent Resources

Online Store
Media Kit
Event Request
Food Services
Library
Childcare Reimbursement
Privacy Policy

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© COPYRIGHT 2026 LIBERTY LIVE CHURCH. ALL RIGHTS RESERVED.

© COPYRIGHT 2026 LIBERTY LIVE CHURCH.
ALL RIGHTS RESERVED.