Westminster Presbyterian Church
Kid's & Student Ministry Activity Release Waiver

Participant Information

Parent/Guardian Information


Emergency Contact 1

Emergency Contact 2

Participant Medical Information

Medical Conditions

Please answer in detail (if applicable) or write N/A. Attach additional pages if necessary.

Medication

Participant Medical Information (Continued)

Waivers & Consents

Voluntary Release - Assumption of Risk & Indemnity Agreement

I (we) hereby release, discharge, and agree not to sue Westminster Presbyterian Church (WPC), its ministers, directors, leaders, employees, and participating volunteers, and all other hosts (Releasees) from all claims and liability arising out of my child's participation in WPC activities. We understand that participation in activities contains certain risks of injuries; that there will be activities held indoors and outdoors, and that there is inherent risk in doing so which we voluntarily assume. I (we) voluntarily elect to accept all risks connected with participation.

Media Consent & Release

I (we) give permission to the release of participant information and authorize permission to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital and printed media to be used in connection with promotion, training, and public awareness of Westminster Presbyterian Church (WPC) events and activities.

Transportation Release

I (we) give permission for my child to be transported to and from church sponsored events and activities in a rental or private vehicle.

Discipline Release

In the event of misconduct, I (we) authorize Westminster Presbyterian to send my child home, at my expense (if applicable).

Medical Consent

I (we), give consent in advance to Westminster Presbyterian Church (WPC) and its designated releasees and to the physicians or hospitals selected by them to have my child (listed above) treated by a physician or surgeon in case of sudden illness or injury while participating in WPC activities or events; including, but not limited to, authorization and consent for hospitalization, diagnosis including taking specimens, and x-ray examination, blood transfusions, and medications, medical anesthetic, and/or surgical diagnosis rendered under the general or special supervision of any member of the medical/dental staff and emergency room staff. It's understood that efforts shall be made to contact the undersigned prior to rendering treatment to the patient, but that nay of the above treatment will not be withheld if the undersigned cannot be reached.

Permission & Acknowledgement

I hereby give permission for my child,
to attend and participate in any Westminster Presbyterian Church Kids and Student Ministry activities, events, retreats, and childcare (as applicable) during the period of January 1, 2026- December 31, 2026. I have read and will abide by the guidance, rules, and regulations of this document and understand it is a release of all claims. I understand that Westminster Presbyterian Church (WPC) and its designated releasees will attempt to contact me before securing medical treatment, if needed, and that by signing this document it does not release the signee from liability from medical cost arising from any treatments given to the participant.