Crown Heights Baptist Church

C.H.A.O.S. Youth — Fall Retreat — October 15–17, 2026

Student Release and Waiver of Claims Form. Please complete every section. A parent or guardian must complete and sign this form for every student attending the retreat.

Student Release and Waiver of Claims

I understand that it is the responsibility of Crown Heights Baptist Church to obtain insurance permission for treatment or to limit my child’s recreational activities because of a stated medical condition.

My child will be attending the C.H.A.O.S. Fall Retreat hosted by Crown Heights Baptist Church, October 15–17, 2026. In the event that my child should need emergency medical care or attention, the retreat leadership, Crown Heights Baptist Church, or any of their agents, staff, or volunteers 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 child’s health insurance information will be given to the health care professional and that any expenses not covered by my insurance shall be my responsibility. I understand that Crown Heights Baptist Church will not be obligated to pay either the health care professional or me for any medical expenses incurred.
• There are instances when third-party vendors, facilities, or contractors (such as retreat centers, outdoor activity providers, or transportation companies) are used to host or supervise events and activities during the retreat. In those instances, I agree that Crown Heights Baptist Church is not responsible for the actions of these third parties, and is not liable for the actions or activities of participants or sponsors participating in events or activities operated by third parties.
• I understand that the risk of injury from recreational activity is significant, including but not limited to, the potential for permanent paralysis and death. While particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. I knowingly and freely assume all risks, both known and unknown, even if arising from negligence, and assume full responsibility for my child’s participation in or observation of such recreational activity.
• Furthermore, in consideration of my child being allowed to attend the C.H.A.O.S. Fall Retreat, I, on behalf of myself and my child, hereby waive, and agree to indemnify and hold harmless Crown Heights Baptist Church and its agents, staff, and volunteers, against any and all causes of action, rights, claims or suits which I or my child may have against Crown Heights Baptist Church or its agents, staff, or volunteers as a result of injury to my child, including, but not limited to: (1) injuries arising from my child’s participation in or observation of recreational activities at the retreat, and (2) injuries arising from the decision of the leadership of Crown Heights Baptist Church or any of its agents, staff, or volunteers to consent to the provision of emergency medical care to my child.
• I understand that my child’s image may be included in a video or in photographs that may be made during the retreat. I understand that a promotional or highlight video may be available afterward. I consent that my child’s image may appear on video, promotional resources, church-endorsed websites, and social media.
• I give authority and permission to Crown Heights Baptist Church and its staff or agents to inspect my child’s belongings while at the retreat.
• I understand that the C.H.A.O.S. Fall Retreat is a place where students often seek counsel and advice from adult leaders, staff, counselors, and others. I hereby consent to my child receiving spiritual and emotional counsel during the retreat.
• I have received and read the Parent Information about the C.H.A.O.S. Fall Retreat, including the list of activities and the daily schedule, and I have received satisfactory answers to all my questions about such information. I have read the C.H.A.O.S. Code of Conduct and Dress Code, and I have discussed the Code of Conduct and dress code with my child.

Student Agreement

All students attending the C.H.A.O.S. Fall Retreat must have a parent or guardian complete and sign this release form.