MEDICAL WAIVER FORM

Student Gender & Grade
Girl
Boy
6th
7th
8th
9th
10th
11th
12th

Parent or Guardian First Name

Last Name

Contact Number

State

Zip/Postal Code

Emergency Contact

State

Zip/Postal Code

Please list each student and any allergies or medical conditions we need to be aware of or write NONE:

Medications/dosage/time of day or write NONE:

E-SIGN BY TYPING YOUR NAME BELOW: I am the parent and/or guardian of said minor(s) above, hereby acknowledge that said minor(s) are under my care, custody, and control. I hereby give the said minor(s) my express permission to travel/participate in church sponsored events and functions of Encounter Students of First Baptist Church of Snyder, Texas from 8/31/2023-08/31/2024. In the event there arises an emergency requiring medical or surgical attention, I hereby consent and give permission to Encounter Students of First Baptist Church of Snyder, Texas and it’s representatives, or any attending physician to make such decisions, and to preform such medical or surgical treatment upon said minor(s), which in their sole discretion, may be reasonable and necessary under the circumstances. I, the undersigned parent and/or guardian of said minor(s), do release, acquit, discharge, and covenant to hold harmless the said Encounter Students of First Baptist Church of Snyder, Texas or its representatives from any and all actions, damages, and/or liabilities arising from the treatment of any sickness or accident incurred by said minor. It is the intention of this release that Encounter Students of First Baptist Church of Snyder, Texas and its representatives incur no liability whatsoever while attending to the reasonable and necessary treatments, surgery and other medical needs that may, in their sole discretion, be needed by said minor(s). *E-SIGN BY TYPING YOUR FIRST and LAST NAME BELOW.

Website, Social Media, Publication, Video, and Photo Release. In an effort to be conscientious about online privacy, we are requesting photo releases from you allowing us to post images of your student(s) on the church website, social media and or Encounter Students of First Baptist Church of Snyder, Texas publications to promote church functions and activities. Students generally will not be identified by name in any photos or text. However, please understand that others outside of church staff may tag your student(s). If there is ever a problem, please feel free to contact Student Pastor Josh Lewis any time. Please check the following. * YES, I allow Encounter Students of First Baptist Church of Snyder, Texas to post images of my student(s) on their website, social media or in church publications. No, my child's picture will not be taken, published, or shared. My child will not be in group/activity pictures and videos.
Yes
No