Youth Issachar

Release of Liability and Media Waiver

By completing this online registration, I agree to ALL the following statements:

1. I hereby acknowledge that Mount Lebanon’s Youth Issachar Conference is not a form of childcare, but a self-governed event. 2. By registering my child, I acknowledge that he/she is old enough and responsible enough to come and go as they please. 3. As the parent/guardian of the registered child to whom this form pertains, I do not hold Mount Lebanon Missionary Baptist Church liable if my child leaves this youth conference or youth conference grounds without permission or with whomever. 4. I grant permission to Mount Lebanon, its employees and agents, to tape and use audio/video image of my child. Audio/video images (A/V) are any type of recording, including but not limited to photographs, digital image, drawings, renderings, voices, sounds, video recordings, audio clips or accompanying written descriptions. The A/V may be used in any manner or media (e.g., publications, promotions, broadcasts, webcasts, advertisements, and posters), without notifying me. I waive any right to inspect or approve the finished images or any printed or electronic matter that may be used with them, or to be compensated for them. 5. I give permission for my child to join the youth of Mount Lebanon Missionary Baptist Church of Chesapeake, VA. in any of the activities or trips sponsored by the church, its staff and sponsors. 6. I hereby release and authorize an adult leader of this activity as agent for me, to consent to any x-ray examination, medical, dental or surgical diagnosis, treatment, and hospital care advised and supervised by a physician, surgeon, dentist (as appropriate) licensed to practice under the laws of the state where services are rendered, either at a doctor’s office or in any hospital.