Young Adults & Baptist Collegiate Ministry
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SEND Network Oklahoma Church Planting
Campers On Mission
GoStudents Release Form
This form is required for all students participating on a GoStudents Mission Project. For students that are 18 but still in the care of parents/guardians, we ask that the form is still completed and signed by the student and parent.
Applicant Full Name
Date of Birth
MM slash DD slash YYYY
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
New York City
In Emergency Notify
Secondary Emergency Contact
Does the student have any known allergies (medicine, food, or other)?
Please list specific allergies
Does the student take any medications regularly?
Please list medications
What reason are these medications taken?
Does the student have any other medical conditions we should know about?
Date of last tetanus immunization
The above named child has current medical insurance coverage through:
Name on Policy
Insurance Company Phone
Does your insurance company require notification prior to emergency health care at a hospital?
Insurance Authorization Phone Number
Please include a copy of the front and back of your insurance card.
Drop files here or
Accepted file types: jpg, gif, png, pdf, Max. file size: 6 MB, Max. files: 3.
Allowed extensions: jpg, gif, png, pdf
Maximum of 3 files under 6MB each
Agreements and Signatures
Participation Consent Agreement
My child will be participating in GoStudents, a ministry operated by the Baptist General Convention of Oklahoma (“Oklahoma Baptists”), in the Summer of 2021. In the event that my child shall need emergency medical attention or care, the GoStudents leadership, Oklahoma Baptists or any of their leadership, or any of the partnering field representative leadership is hereby authorized to consent to the provision of such emergency medical care, including without limitation, medical, dental, surgical care, or hospitalization, to my child as is recommended or suggested by a physician, nurse, surgeon, or other health care professional.
If such emergency care is provided, I understand that my health insurance information will be given to the health care professional and that any expenses not covered by my insurance or travel insurance shall be my responsibility. I understand that Oklahoma Baptists will not be obligated to pay either the health care professional or me for any medical expenses incurred.
I understand that the risk of injury from any recreational activity is significant, including, but not limited to the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. While particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist.
Furthermore, the Parent releases and promises to indemnify, defend, and hold harmless Oklahoma Baptists and its agents, employees, volunteers, or any other representatives for any injury related directly or indirectly out of the listed ministry projects, whether such injury arises from the negligence of GoStudents or otherwise.
I understand that if behavioral issues arise, I will be solely responsible for the financial burden of any expenses incurred by GoStudents. This includes but is not limited to property damage, transportation (flight, travel, etc.), or any other financial decisions made by GoStudents because of a behavioral issue of the participant.
I understand that my child’s name and image may be included in video or photographs that may be made during the GoStudents project or training. I understand that a promotional or highlight video may be available for sale during and/or after the project. I consent that my child’s name and image may appear on videos, promotional resources, GoStudents endorsed web sites, printed or electronic publications, etc.
I give authority and permission to Oklahoma Baptists and any of their staff or agents to inspect my child’s belongings while on a GoStudents Project if the need arises.
I understand that there will be some form of communication from Oklahoma Baptists (including GoStudents or Coordinators representing GoStudents) with myself and my student via phone calls, texts, messages, and/or emails.
I have received and read the Parent information about GoStudents, and I have received satisfactory answers to all my questions about such information. I have read and reviewed with my child the GoStudents Code of Conduct and Dress Code.
COVID-19 Release and Waiver
RELEASE AND WAIVER. In consideration of my child participating in the GoStudents mission trip (“Missions Trip”), I, as guardian, do hereby forever release, waive, discharge, and covenant not to sue and its past, current, and future officers, directors, employees, members, volunteers, contractors, representatives, parents, owners, affiliates, agents, successors, and assigns (collectively, “Oklahoma Baptists”) from any and all damages, injuries, losses, liability, claims, causes of action, litigation, or demands, including but not limited to those for personal injury, sickness, or death, as well as property damages and expenses, of any nature whatsoever which may be incurred, directly or indirectly, now or in the future, in any way related to COVID-19 and in connection with my child’s participation in the Missions Trip or any travel related thereto. I promise not to sue Oklahoma Baptists for any of the foregoing.
ASSUMPTION OF RISKS. I understand that while Oklahoma Baptists has undertaken reasonable steps to lessen the risk of transmission of COVID-19 in connection with the Missions Trip, Oklahoma Baptists is not responsible in any manner for any risks related to COVID-19 in connection with the Missions Trip. I understand that the World Health Organization has classified the COVID-19 outbreak as a pandemic. I further understand that COVID-19 is a highly contagious and dangerous disease, and that contact with the virus that causes COVID-19 may result in significant personal injury or death. I am fully aware that participation in the Missions Trip (including any related travel) carries with it certain inherent risks related to COVID-19 transmission (“Inherent Risks”) that cannot be eliminated regardless of the care taken to avoid such risks. Inherent Risks may include, but are not limited to, (1) the risk of coming into close contact with individuals or objects that may be carrying COVID-19; (2) the risk of transmitting or contracting COVID-19, directly or indirectly, to or from other individuals; and (3) injuries and complications ranging in severity from minor to catastrophic, including death, resulting directly or indirectly from COVID-19 or the treatment thereof. Further, I understand that the risks of COVID-19 are not fully understood, and that contact with, or transmission of, COVID-19 may result in risks including but not limited to loss, personal injury, sickness, death, damage, and expense, the exact nature of which are not currently ascertainable, and all of which are to be considered Inherent Risks. I hereby voluntarily accept and assume all risk of loss, personal injury, sickness, death, damage, and expense arising from such Inherent Risks. Furthermore, I represent and warrant that my child does not suffer from any medical condition or disease that might in any way hinder or prevent him or her from going on the Missions Trip, including, to my knowledge, COVID-19.
This COVID-19 Assumption of Risk, Release, and Waiver of Liability Agreement (“Agreement”) shall be binding on my heirs, executors, administrators, successors, and assigns. I expressly agree that this Agreement is intended to be as broad and inclusive as is permitted by applicable laws, and that if any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. This Agreement contains the entire understanding of the parties relating to the subject matter, and shall not be altered, modified, amended, waived or supplemented in any manner whatsoever except by a written agreement signed by both parties hereto or their duly authorized representatives. This Agreement may be executed, made and delivered electronically.
I have read and understood this Agreement and enter into it voluntarily in consideration of the opportunity for my child to participate in the Missions trip. I acknowledge I am giving up legal rights and/or remedies which may be available to me and my child.
Relationship to participant
Is the participant 18 years or older?
Virtual Missions Center