Mt. Zion Baptist Church VBS Liability Agreement
I, the undersigned parent/guardian of the child(ren) listed above, hereby grant my consent for my child(ren) to participate in the vacation bible school program sponsored by Mt. Zion Baptist Church. I certify that my child is able to participate in the following activities:
Use of kid-safe scissors and other craft supplies, Use of glue, paint, and markers (potential allergies or stains) Snack time, Playing active games, Use of play equipment, Moving from room to room, Using stairs, Sitting on chairs/benches, Handling small objects, Participation in group singing, Participation in prayer, Possible emergency situations (fire drills, severe weather, lockdowns), Bathroom policies (ensuring proper supervision and safety), Outdoor activities, Use of electronics in the classroom, Potential exposure to mild cleaning agents (wiping tables, washing hands, etc.).
This program will take place from 5:00 PM to 8:00 PM on the following dates in 2026
June 21st - 25th
Emergency Medical Consent:
If my child has medical conditions that may be relevant to a physician in the event of an emergency, I understand that it is my responsibility to make it known to the Mt. Zion Baptist Church staff and VBS leadership. In the event of a medical emergency, I authorize Mt. Zion Baptist Church to secure any necessary medical treatment for my child(ren). I understand that every reasonable effort will be made to contact me before any action is taken. In the event an emergency occurs, I may be reached at the telephone number(s) listed above. If I cannot be reached, I hereby authorize the pastor, deacons, and VBS director to make emergency medical decisions for my child.
Behavioral Policy:
I understand that Mt. Zion Baptist Church expects all children to follow appropriate behavior guidelines for a safe and positive learning environment. In the event of disruptive or unsafe behavior, I agree to be contacted and cooperate with the church to address the matter.
Allergy and Dietary Disclaimer:
Mt. Zion Baptist Church will make every effort to accommodate allergies and dietary restrictions disclosed. However, I understand that the church cannot guarantee a completely allergen-free environment.
Snack Consent:
I give my permission for Mt. Zion Baptist Church, its staff, teachers, volunteers, and leadership to provide my child(ren) with snacks during Vacation Bible School. I understand that every effort will be made to accommodate dietary restrictions and allergies disclosed on this form. I also acknowledge that it is my responsibility to communicate any specific dietary needs or restrictions for my child.
Audio/Video Surveillance Agreement:
I acknowledge and agree that, for the safety of the children, teachers, and the church, all rooms may be equipped with audio and video-capable surveillance systems. I understand that:
Surveillance footage will only be used for security purposes.
Footage will only be viewed by church staff, leadership, and the security team unless ordered by a court to present it for a legal matter.
Footage will never be used for internet use, entertainment, or non-security purposes.
Media Release:
I give my consent for Mt. Zion Baptist Church (MZBC) to photograph and/or record video of my child(ren) during Vacation Bible School for use in church services, promotional materials, the church website, and the church's YouTube channel.
I acknowledge and understand that MZBC will make every reasonable effort to honor my request if I choose not to consent. However, I recognize that MZBC cannot guarantee my child will not be photographed or included in such content. By signing this agreement, I agree to hold MZBC harmless and release them from any liability should my child appear in media content.
Acknowledgment and Agreement
I understand and hereby agree to assume all of the risks which may be encountered at vacation bible school, including activities preliminary and subsequent thereto.
I do hereby agree to hold Mt. Zion Baptist Church and its agents and employees harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which my child now has or which may arise in the future in connection with the activity or participation in any other associated activities. I also specifically agree that Mt. Zion Baptist Church shall not be responsible for any such injuries, loss, or damage, even in the event of negligence or fault by Mt. Zion Baptist Church.
I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the law of the State of Kentucky and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto, and the terms of this release are contractual and not a mere recital.
I understand this is a legally binding agreement. I further state that I have carefully read the foregoing release and fully understand the contents thereof, and I sign this release of my own free will.
