2025 Double Springs - Individual Liability Release

Do you or your family have medical coverage?

In consideration of being allowed to participate in any way in Double Springs Baptist Church related events and activities, the undersigned acknowledges and agrees to each of the following:
I authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

I understand that I shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.

Should it be necessary for our (my) child to return home due to medical reasons, behavior reasons, or otherwise, the undersigned shall assume all transportation costs, including the costs of the accompanying chaperone. I understand that if any incident requires police response, my child will be released to local police.

I hereby give permission for our (my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by Double Springs Baptist Church. I understand that all reasonable safety precautions will be taken by the leaders of this activity, and that the possibility of an unforeseen hazard does exist. I further agree not to hold Double Springs Baptist Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred.

I hereby grant Double Springs Baptist Church permission to use my likeness and my child's
likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of Double Springs Baptist Church and will not be returned.

I hereby irrevocably authorize Double Springs Baptist Church to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable. By electronically signing and submitting this agreement, I 1) acknowledge that I have read and fully understand the terms of the agreement; 2)voluntarily agree to be bound by this agreement; and 3) certify that I am 18 years of age or older.

A parent or legal guardian must sign this agreement on behalf of any minor participant under the age of 18. By electronically signing this agreement, I represent that I have the authority to sign and enter into this agreement on behalf myself or of the minor(s) listed above.

IN SUBMISSION OF YOUR ELECTRONIC SIGNATURE, PLEASE TYPE YOUR FULL LEGAL NAME.