Mount Olive Baptist Church Health Record Permission Form
Note to Parent/Guardian:  It is important that you complete the following Health Record.  Your son/daughter must present it before attending the student activities.
  • Parent (legal guardian), I do hereby grant full and absolute release from any liability on the part of Mount Olive Baptist Church, it’s leaders and supervisors, for youth/children’s activities and trips.
  • We grant permission for Child/youth to fully participate in the Activity;
    We release, discharge and hold harmless the Mt Olive Baptist Church (MOBC), its members, employees and program volunteers, from any and all claims, liabilities or demands whatsoever for personal injury, sickness, death, property damage or expense, of any nature whatsoever, which may be incurred by the undersigned or Child/youth in connection with Child’s/youth’s participation in the Activity, except to the extent that such injury, sickness, death, property damage or expense is incurred as the result of the gross negligence or intentional misconduct of MOBC;
  • We grant MOBC permission to seek medical treatment it deems necessary for Child/youth while engaged in the Activity.
  • We grant permission to MOBC to furnish transportation, food, and lodging to Child/youth as it deems appropriate;
  • We agree to assume all transportation costs incurred on behalf of Child/youth in the event that MOBC determines, for any reason, that it is necessary or advisable for Child/youth to return home;
  • We agree to defend, indemnify and hold the MOBC harmless from and against any and all claims, demands, liabilities, and damages whatsoever resulting, directly or indirectly, from the negligence or intentional conduct of Child/youth.

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