Manolo Youth Group Trip Packet

This trip packet must be completed for every student who attends youth group or attends a youth group trip off-campus. This includes friends as well. It provides the needed contact information, medical information, and waiver information so that we can best serve students and families. Before you begin, make sure you have your child's insurance card and doctor's contact information close by since you will need it to complete this form.

If you have questions, you can contact Pastor Josh by

email: berlinbcjosh@gmail.com or by phone: 989-640-1879

Thank you for trusting us with your student and for taking the time to give us the information we need to best serve you. God bless!

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

Please note all medications need to be turned into the leaders. If your child suffers from severe allergic reactions and carries an Epi-pen or has severe asthma and needs an inhaler at all times, please explain below and notify the leaders.

By signing below, you are stating that the above information is true to the best of your knowledge and that you hereby consent for medical care to be given to your student (listed above) in case of an emergency.

IN CONSIDERATION of my child (state above) being permitted to participate in the Berlin Baptist Church field trips and activities with Pastor Josh Feldpausch and any other adults (Youth Leaders) involved in planning and/or participating in the trips and activities:

1. I give my full permission for my child (stated above) to participate fully in the church field trips and activities.
2. I assume all risk of my child’s participation in the church field trips and activities, including any risk associated with any special medical needs of my child.
3. I, the Parent/Guardian (stated above), for myself, my child, my child’s heirs, personal representatives, and assigns, hereby release, discharge and agree to hold harmless the Youth Leaders and Berlin Baptist Church from all liability, loss, claims, demands and possible causes of action that may accrue from any loss, damage or injury to person or property in any way resulting from or arising in connection with or related to my child’s participation in the church field trips and activities. It is fully understood that this means that the Youth Leaders and Berlin Bapist Church cannot be sued if any personal injury is suffered by my child during the church field trips and activities or if any property is damaged, lost, or stolen while my child participates in the church field trips and activities, except to the extent that such injury to person and/or loss of or damage to property results from a grossly negligent, intentional or malicious action, failure to act or omission by the Youth Leaders and Berlin Baptist Church.
4. I, on behalf of my child, as well as for myself hereby undertake to indemnify (cover) the Youth Leaders and Berlin Baptist Church against any and all liability, loss or damage for which the Youth Leaders or Berlin Baptist Church may be found liable as a result of claims, demands or judgments against them or any of them arising from any act or failure to act on the part of my child during the course of the church field trips and activities. It is fully understood that this means that if my child causes injury to another person or damages another person’s property while involved in a church field trip or activity, and the Youth Leaders or Berlin Baptist Church have to pay an amount to that person, Berlin Baptist Church can recover the amount paid from the Parent/Guardian (listed above).
5. While the Youth Leaders will make every reasonable effort under the circumstances to contact the Parent/Guardian in the event my child faces a medical emergency, the Parent/Guardian hereby authorizes each of the adult Youth Leaders to secure medical treatment by medical professionals, at my expense, for any injury or illness suffered by my child, as may be necessary to stabilize my child and to minimize additional injury or affects of illness during whatever time on the church group field trips it takes to contact Parent/Guardian for further instructions.

I HEREBY DECLARE THAT I HAVE READ THIS RELEASE AND INDEMNITY AGREEMENT AND ACCEPT THE SAME IN FULL ON BEHALF OF MYSELF, MY SPOUSE, MY CHILD, MY CHILD’S HEIRS, PERSONAL REPRESENTATIVES AND ASSIGNS.

This agreement is made for my child (listed above) on the following date: