Student Release Form - Bethel Youth Ministries

Bethel Students is the middle school and high school ministry of: Bethel Church, 2700 W Philip Ave., North Platte NE, 69101, Phone: 308-532-7040, http://bethelnp.org.

Student's Information

* 1 student per 1 form *

Medical Treatment / Travel / Photo / Liability

I give permission for my above-named child to join the Bethel Church and Bethel Students for on-site and off-site activities. I understand that the leadership has done their best to ensure my child’s safety but I understand that accidents may occur. I hereby release Bethel Church, its staff, and its sponsors from responsibility and liability for any injury or illness that my child may sustain during youth group activities in transportation or at the actual event.

In case of an emergency, I hereby authorize and appoint an adult leader of this activity as agent for me to consent to any medical treatment my child may require, including any x-ray examination, medical, dental, or surgical diagnosis, treatment, and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate), licensed to practice under the laws of the state where the services are rendered, either at a doctor’s office or in any hospital. 
I expect to be contacted as soon as possible. 

I release my child for photos and appropriate video to be used indefinitely in brochures, on church/student ministries' social media, on the church/student ministries website(s), and audiovisual productions for church events. This permission is revocable, in writing, to Bethel Church at the discretion of the parent or legal guardian. I understand that the church staff and volunteers will use good judgment in posting pictures, ensuring names and personal information are kept private. 

Typing your name in this box serves as your electronic signature.

Date

Parent/ Guardian Information

Emergency Information

Medical Information

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