Central Baptist Church - Crockett, TX

Rooted Student Ministry - Registration Form

Please complete the ENTIRE form. You may add additional students if needed by clicking "Add Another Student" below.

Student Information:
Add Additional Students at the Bottom

Student First Name

Student Last Name

Gender

Birthdate

School

Student Grade

Does The Student Have Any Known Allergies?

YES

NO

Student Allergies

Does the Student Have Any Important Medical Information We Need to Be Aware of?

YES

NO

Student Medical Information

CLICK BELOW TO ADD ADDITIONAL STUDENTS:

Parent/Guardian Information:

Parent or Guardian's Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Parent/Guardian Phone Number

Secondary Number

Parent/Guardian Email

Emergency Information:

In Case of an Emergency, Please Contact:

Emergency Contact Phone:

Release Form:

Rooted Student Ministries (“RSM”) is a ministry of Central Baptist Church (“CBC”). This release form must be signed by a parent or legal guardian and, when appropriate, by the participating student. It is designed to be legally sound under Texas law. If any portion of this agreement is held invalid, the remainder shall continue in full force and effect.

Transportation Release:

I give my consent for the student named above to ride in vehicles operated by adult leaders of Central Baptist Church. These leaders are trained and certified by CBC to transport students in church‑owned or personal vehicles.
By signing below, I acknowledge and agree to the following:

Rule compliance. My student will comply with all instructions and safety rules issued by RSM leaders. Failure to follow directions may result in loss of riding privileges and, if necessary, removal from the activity.
Assumption of risk. I understand that transportation can involve risks such as vehicular accidents or injuries. I voluntarily assume full responsibility for these risks on behalf of my child and myself.
Release of liability. I EXPRESSLY RELEASE AND AGREE TO HOLD HARMLESS CBC, RSM, THEIR OFFICERS, EMPLOYEES, VOLUNTEERS, AND AGENTS FROM ANY AND ALL CLAIMS FOR INJURY, LOSS OR DAMAGE ARISING FROM TRANSPORTATION, INCLUDING CLAIMS CAUSED BY CBC’S OR ITS LEADERS’ NEGLIGENCE, EXCEPT FOR CLAIMS RESULTING FROM GROSS NEGLIGENCE OR INTENTIONAL MISCONDUCT.
Indemnification. To the fullest extent permitted by law, I agree to indemnify and defend CBC and RSM against any claims or damages arising from my child’s actions during transportation.

I Consent To The Above:

Yes

No

Media (Photo/Video/Likeness) Release:

Rooted Student Ministries desires to celebrate and promote its activities. Photographs or videos of students may be used in printed materials, slideshows, the CBC/RSM website, and official social media accounts.

Permission. I grant CBC and RSM, and those acting with their permission, the perpetual right to photograph, videotape, or otherwise record the student’s image, voice, and likeness during ministry activities. I further grant CBC and RSM the right to use, reproduce, publish, distribute, and display these recordings in any medium, now known or later developed, for lawful, non‑commercial purposes such as promotion, publicity, illustration, and advertising.
No compensation or rights. I understand that neither my child nor I will receive any form of payment or royalties for the use of the student’s likeness. We relinquish any rights of ownership, inspection, or approval of finished products and waive any claims for libel, invasion of privacy, or misappropriation.
Opt‑out option. If I do not want my child’s image used, I will check the box labeled "NO" below. Failure to check the box will be deemed consent.

I Agree To The Above:

YES

NO

General Release & Participation Agreement:

By allowing my child to participate in Rooted Student Ministries, I acknowledge and agree to the following:

Voluntary participation. I give permission for my child to participate in all RSM activities, including worship services, small groups, recreation, field trips, and service projects. I understand that activities may involve inherent risks of injury or property damage.
Behavior expectations. My child agrees to act responsibly and respectfully, to follow RSM rules and instructions, and to refrain from possessing tobacco, alcohol, illegal substances, or weapons. Disruptive or unsafe behavior may lead to disciplinary action or dismissal from the activity.
Assumption of risk & release. I KNOWINGLY ASSUME ALL RISKS OF PARTICIPATION AND RELEASE CBC, RSM, AND THEIR LEADERS FROM ANY AND ALL CLAIMS FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH ARISING FROM PARTICIPATION, INCLUDING CLAIMS CAUSED BY CBC’S OR ITS LEADERS’ NEGLIGENCE, EXCEPT FOR CLAIMS BASED ON GROSS NEGLIGENCE OR INTENTIONAL ACTS.
Acknowledgement regarding minors. I understand that Texas courts have questioned whether parents can waive a minor child’s personal‑injury claims. Nonetheless, I sign this release with the intent that it be enforced to the fullest extent permitted by law and that it will bar my derivative claims (e.g., loss of consortium) even if my child’s claims are not waived.
Indemnification. I agree to indemnify and hold harmless CBC, RSM, and their leaders against any liability, damage, or expense (including attorney’s fees) arising from my child’s participation or conduct.
Insurance & adult supervision. I acknowledge that CBC maintains liability insurance and uses trained, screened adult supervisors. I understand that adult supervision is required for all RSM activities and that I remain responsible for instructing my child to abide by the rules.

I Agree To The Above:

YES

NO

Signatures:

Parent/Guardian Signature:

By signing, I acknowledge that I have read this form in its entirety, understand its terms, and sign it freely and voluntarily. I am aware that by signing this form, I am releasing certain legal rights on behalf of myself and my child.

Parent/Guardian Signature

Printed Name

Date of Signature

Student Signature (ALL STUDENTS MUST SIGN)

As the participating student, I agree to respect all adult leaders and other participants, to follow the rules and instructions provided by RSM leaders, and to refrain from any behavior that is unsafe, disruptive, or disrespectful. I have been given a copy of the Rooted Student Ministries student handbook, I have read it, and I understand the rules and expectations outlined within. I understand that failure to follow these rules may result in loss of privileges or dismissal from the activity, and I will accept the consequences of my actions.

STUDENT Signature