Consent Form

To validate your registrant(s), you must complete the form and signature at the bottom of this page. You may sign one form for multiple participants, but each name must be included on the form.

I hereby give approval for my child’s participation in any and all activities prepared by Starmount ARP Church during the Vacation Bible School 2023 (June 21^st through June 23^rd , from 9 a.m.-12p.m.). I understand that the pastors, volunteers, agents, and employees will supervise the children during the activities. I understand There is a risk of being injured that is inherent in all physical activities, including those conducted in VBS games and activities, and I accept those risks and affirm that my child is physically able to participate.

With that understanding I assume all risks and hazards incidental to the conduct of the activities and release, absolve and hold harmless Starmount ARP Church and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of, traveling to, participating in, or returning from VBS 2023 activities.

Medical Authorization and Consent

In the event of an emergency or non-emergency situation in which medical treatment is necessary as a result of participation in the VBS 2023, every reasonable effort will be made to contact the person listed in this form.

For the protection of life and limb of the named minor child, in my absence, permission is hereby granted to the attending physician to proceed with any X-ray, examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care for the named child if deemed necessary. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible.

Permission is also granted to Starmount ARP Church and its affiliates to provide the needed emergency treatment prior to the child’s admission to the medical facility and to act in my behalf to secure hospitalization or medical services deemed necessary.

I furthermore release and hold harmless Starmount ARP Church, including all instructors and affiliates, all participants, and board of directors of any claims or any liability related to COVID-19 and or other viruses which might occur as a result my child’s being on the premises and participating in the activities.

Promotional Release

I also give my permission to Starmount ARP Church the irrevocable right to photograph, videotape and/or record audio of my minor child and/or myself while participating in VBS activities and to use these images and/or recordings for promotional purposes. I agree that Starmount ARP Church will not be liable for any injury attached to the use of my child picture. In this regard, I understand these images and/or recordings may be used in perpetuity, with or without edits to the originals.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE.

I AM AGREEING THAT THE INFORMATION I HAVE SUBMITTED ON THIS FORM IS COMPLETE AND ACCURATE AND THAT, AS THE LEGAL PARENT AND / OR GUARDIAN, I HAVE THE LEGAL RIGHT TO ENTER INTO THIS AGREEMENT.

 Attention: This event is for children ages 5 – 12 years old