Participant 1 Information
Participant 2 Information
Participant 3 Information
Medical & Liability Release
During activities at or sponsored by St. Martin-in-the-Fields Episcopal Church, in the event of sickness or medical emergency, I request that my child receive any medical attention or treatment deemed necessary. I give permission to any hospital, doctor, or health care provider to transport, treat, admit, and/or care for my child. In the event that I am not present at the time of the emergency or cannot be contacted, I entrust my child's care to the staff and/or designated ministry leadership of St. Martin-in-the-Fields Episcopal Church.
I grant to St. Martin-in-the-Fields Episcopal Church and to the Episcopal Diocese of Texas, their representatives and employees the right to take photographs, video recordings, and sound recordings of my child. I authorize St. Martin-in-the-Fields Episcopal Church and to the Episcopal Diocese of Texas its assigns and transferees to alter, copyright, use and publish the same in print and/or electronically, with or without my child's name, for any lawful purpose, including such purposes as publicity, illustration, advertising, displays, and internet content. I hereby waive any right that I may have to inspect or approve photo, video, or sound products. In addition, I waive the right to any compensation related to their use.
If you do not waive the right to photos, videos, etc. please provide an image of your child to better assist us with assuring their likeness is not used.
If you have additonal children, please fill out a second form.
If you pay by check, please write VBS and YOUR CHILD'S NAME in the memo. Thank you!
