Parents/Guardians Consent Form  

To:  First Baptist Church Youth Ministries         204 W Fulton                               DeKalb,TX  75559       

Participant___________________________________________________________________________

Address_______________________________ Parents/Guardians _______________________________

City____________________State________Telephone________________________________________                                                                                                                                                                                               Home                                                       Work/Cell

Age_____ Birth Date_______ Alternate Contact______________________________________________                                                                                                                                                                                                   Name                                                                                        Phone

We, the undersigned parents/guardians of the above named participant, grant permission for the participant to participate in the following activity.                                                                                                           The participant agrees to stay with the group and to abide by the guidelines as written in the Cross Training Handbook.

Activity ________________________________________________________________  Date(s)_________________________________

  We have been advised of the nature and extent of the activities that may take place and represent to you that the participant is physically and mentally                                                                                                        able to participate in those activities.

We understand that the activity does present the risk of injury, or even death, to the participant, and we have advised the participant of those possibilities.                                                                                            We represent to you that we and the participant assume the risk of any such injury or death, and hold you, your agents, employees, and representatives harmless                                                                               from any liability for injury or death to the participant while engaged in this activity which is caused or contributed to by the conduct of the participant, and agree                                                                                     to indemnify and defend you against any claim or liability asserted against you for any such injury or death to participant.

We also hold you, your agents, employees, and representatives harmless from all liability to any other person or entity arising as a result of the conduct of the                                                                           participant in this activity and agree to defend and indemnify you, your agents, employees, and representatives against any claim or liability arising as a result of such                                                                    conduct.

If we are not personally present at these activities in which the participant is to participate, so as to be consulted in the case of necessity, you are authorized on our                                                                        behalf to arrange for such medical and hospital treatment as you may deem necessary for the health and well being of the participant.

The activity begins at First Baptist Church and should return by  on     

 I authorize transportation by First Baptist Church Vehicles or Member Vehicles.

Participant Signature ______________________________________________Date____________________

Parents/Guardians Signature ___________________ ________________Date__________________

Additional Information

Medical / Health Insurance Company___________________________________________________

 Policy Number____________________________________________________________________

 Allergies / Allergic reaction of my child__________________________________________________

 Medicine being taken by my child______________________________________________________