Student Release Form for Events and Activities

Student Name:




Student's Mobile Phone # :

Parent Mobile Phone #:

Parent Email:


The undersigned desires to participate in the various programs, events or activities (herein collectively referred to as activities) operated or sponsored by Midlothian Bible Church, (herein after referred to as MBC). The undersigned further understands and acknowledges that the undersigned, or a member of the immediate family of the undersigned, may incur personal injury or bodily harm while participating in such activities. The undersigned further understand and acknowledges that MBC would not allow the undersigned to participate in such activities without releasing and holding harmless MBC. Further, the undersigned requests that MBC allow him/her to participate in MBC activities, in consideration there of agree to hereby release, and forever discharge MBC, its officer and directors, and its employees, their agents and parties volunteering on behalf of MBC from all actions, causes of actions and claim damages of any kind growing out of, or related to any activity of MBC in which the undersigned participates. The undersigned also acknowledges that this is a full and complete release of all injuries and damages that the undersigned may sustain as a result of the undersigned’s participation in the event indicated below. I do consent to the use of my voice, likeness and photographic or video graphic image by MBC and, in consideration for participating in this program, I hereby grant MBC permission to photograph or video my image and that of my minor children participating in such program and consent to the use of such voice, likeness, and image by MBC and its employees, agents, and contractors for any or all church-sponsored communications (including but not limited to newsletters, brochures, worship folders, video productions, social media, email, church website and advertisements) and to make changes or alterations to such voice, likeness and images as MBC deems proper. The permission granted hereby shall pertain to any such image taken prior to MBC of written notice from me revoking the consent granted.:




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Signature Certificate
Document name: Student Release Form for Events and Activities
lock iconUnique Document ID: 5d5d81928a4498bd6df367a1f1b877296ec9fc0d
Timestamp Audit
February 16, 2022 3:40 pm CDTStudent Release Form for Events and Activities Uploaded by Sherri Hatcher - IP