CONSENT AND RELEASE FORM
El Camino Baptist Church
I the undersigned parent or guardian, hereby consent for my child, ______________________________
________________________________________, participating in ______________________________
_________________________________________, an event sponsored by El Camino Baptist Church on
_________________. If my child has medical conditions, which may be relevant to a physician in the
event of an emergency, I have listed them below. If I cannot be reached, I hereby authorize agents of El
Camino (an adult sponsor) to make emergency medical decisions for my child. If there are activities I
do not want my child to be involved in, I have listed them below. I UNDERSTAND AND HEREBY
AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID
ACITIVY, INCLUDING ACITIVIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby
agree to hold El Camino Baptist Church and its agents and employees, harmless from any and all
liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or
property, even injury resulting in death, which I now have or which may arise in the future in connection
with the activity or participation in any other associated activities.
__________________________ _________________
Parent or Guardian Date
Medical conditions of which to be aware:
_____________________________________________________________________________
_____________________________________________________________________________
Telephone numbers where I may be reached in an emergency:
________________________________________________________
Any other helpful information:
________________________________________________________
I the undersigned parent or guardian give consent for my child to drive with
_____________________ to or from the ABOVE youth activity.
_____________________________ ___________________
Parent or Guardian Date