| FIRST BAPTIST CHURCH COLUMBUS, TX GOING AND GROWING IN THE LORD |
| Affiliated with the Southern Baptist Convention |
| PERMISSION FOR STUDENT PARTICIPATION ON TRIPS TAKEN BY THE FIRST BAPTIST CHURCH OF COLUMBUS, TX YOUTH MINISTRY |
employees, and sponsors harmless from all claims or actions which I or my child ever had, now have, or
may have in the future or any liability for injuries or damages which occur to my child or to me as a result
of his or her participation on these trips.
I expressly waive all claims for medical expenses, loss of services, or other claims, and I agree to and
sponsors from all claims made against it or them on behalf of my child.
I agree to indemnify and hold harmless the First Baptist Church of Columbus, TX, its Trustees,
employees, and sponsors from all claims made by third parties against it or them which result from my
child’s actions on these trips.
Family Physician phone .
Medical insurance company: .
Ins. Co. phone: Policy number: .
Telephone number of parent or other emergency contact: .
Alternate #: alternate #: .
Medication currently taking (if any): .
Allergies? .
Other pertinent information? .
I have read and understood this release and sign it voluntarily and with full knowledge of its significance.
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Signature of Student Date
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Signature of Parent Date