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First Presbyterian Church of Edmond
Student Ministry Academic Year General Liability Release Form
(August 2016 - August 2017)

In consideration for being accepted by First Presbyterian Church of Edmond (FPCE) for participation in their Student Ministry Events we (I) being 18 years of age or older, do for ourselves (myself) (and for and on behalf of my child-participant if said child is not 18 years of age or older), do hereby release, forever discharge and agree to hold harmless FPCE and the directors, employees, agents and volunteers thereof from any and all liability claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child participant, that occur while said child is participating in the above-described trip or activity.

Furthermore, we (I) [and on behalf of our (my) child-participant if under the age of 18 years] hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein.  Authorization and permission is hereby given to said church to furnish any necessary transportation, food, and lodging for this participant.

Pictures taken by FPCE staff are property of FPCE Student Ministries and may appear on the website or Facebook page or other social media sites. The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees, agents and volunteers, for any liability sustained by said church as the result of the negligent, willful, or intentional acts of said participant, including expenses incurred attendant thereto. This form is valid for all FPCE Student Ministry Events until August 31, 2017.

(If the participant has not attained the age of 18 years):

We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including, but not in limitation to emergency surgery or other medical treatment, and assume the responsibility of all medical bills, if any.  Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action, or otherwise, we (I) hereby assume all transportation costs for student and an adult chaperone of the same sex.

Participant Information

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Parent/Guardian Contact Information



Medical Emergency Contact

Health Insurance Information

Participant Health Information

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Medical Release

I/we understand that, in the event medical intervention is needed for (enter full name of student participant below), every attempt will be made to contact immediately the person(s) listed on this form. I/we authorize an adult sponsor or leader to consent to an X-ray examination, anesthetic, medical, surgical or dental diagnosis and treatment and/or hospital care, and the administration of drugs or medicine to be rendered to my child. These shall be provided under the general or specialialized supervision of, and upon the advice of, any physician and/or surgeon 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/we understand and agree that I/we shall be responsible for and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to my child. I/we affirm that the health insurance information provided is accurate at this date and will, to the best of my/our knowledge, still be in force for my child. I/we also agree to assume all transportation costs should it be necessary for my child to return home due to medical reasons.
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Student Code Of Conduct Covenant

I understand that it is my obligation to have a positive influence on my peers and to abide by the rules and regulations of the trip. I recognize that I am a representative of Jesus Christ and the First Presbyterian Church of Edmond and that appropriate conduct is essential. I will treat my peers in a way that brings honor to God (including, but not limited to, being on time to events, dressing appropriately, refraining from put downs or sarcasm, inappropriate jokes, gambling for money, and foul language.)

I agree to abide by the following rules and consequences: *
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I/We have reviewed the Student Code of Conduct Covenant with my/our child and understand that I/we am/are responsible for all related return travel expenses if the situation warrants my child being sent home from the trip.
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Video/Photo Release

I give my permission to First Presbyterian Church of Edmond to use my name and photographic and/or video likeness in all forms and media for any appropriate or publicity use.
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