Youth Registration and Medical Release

In order to allow minors to attend Youth@TMBC events, a parent must fill out and electronically sign this form. Please fill out one form per child in order to specify any medical concerns or allergies of each child.

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Insurance Information
Medical Information

BY ELECTRONICALLY SIGNING THE FORM BELOW, IN CASE OF A MEDICAL EMERGENCY, I GIVE PERMISSION FOR THE ABOVE-NAMED MINOR TO RECEIVE MEDICAL CARE DEEMED BEST BY THE TMBC STAFF AND LEADERSHIP. I UNDERSTAND THAT REASONABLE CARE WILL BE TAKEN BY TMBC TO ENSURE THE SAFETY OF THIS MINOR. I AGREE THAT ANY DISPUTE, CONTROVERSIES, OR CLAIMS ARISING OUT OF OR RELATING IN ANY WAY TO THE MEDICAL TREATMENT OF THIS MINOR SHALL BE EXCLUSIVELY RESOLVED BY MEDIATION OR BINDING ARBITRATION ACCORDING TO TMBC’S MEDIATION-ARBITRATION POLICY, WHICH TMBC HAS MADE AVAILABLE TO ME. I AFFIRM I AM A LEGAL GUARDIAN OF THE MINOR LISTED IN THIS FORM AND I AM AUTHORIZED TO SIGN THIS MEDICAL RELEASE FORM ON HIS OR HER BEHALF.

I hereby give my permission for my child to attend The Mount Bible Church’s youth ministry gatherings and events. I understand that there will be adult supervision.

I UNDERSTAND THAT REASONABLE CARE WILL BE TAKEN BY TMBC TO ENSURE THE SAFETY OF THIS MINOR BY TMBC LEADERSHIP AND ITS AGENTS. I AGREE THAT ANY DISPUTE, CONTROVERSIES, OR CLAIMS ARISING OUT OF OR RELATING IN ANY WAY TO TMBC’S SUPERVISION OF THIS MINOR SHALL BE EXCLUSIVELY RESOLVED BY MEDIATION OR BINDING ARBITRATION ACCORDING TO TMBC’S MEDIATION-ARBITRATION POLICY, WHICH TMBC HAS MADE AVAILABLE TO ME. I AFFIRM I AM A LEGAL GUARDIAN OF THE MINOR LISTED IN THIS FORM AND I AM AUTHORIZED TO SIGN THIS PERMISSION SLIP ON HIS OR HER BEHALF.

The Mount Bible Church has my permission to include my child in photos and video taken during youth ministry gatherings and events which may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.

  • (818) 798-1773
  • info@themountbc.org
  • 20553 Sherman Way
    Winnetka, CA 91306

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Thank you for registering your child. We will review your form soon, and if we have any questions, we’ll be in touch! God bless!
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Mandate of Mediation & Arbitration Define

  1. The Lord Jesus Christ through His Word, the Bible, commands us to make every effort to live at peace and to resolve disputes with each other in private or within the Christian community in conformity with the Biblical mandates, which include, but are limited to, I Corinthians 6: 1-8, Matthew 5:23-34, and Matthew 18:15-20.
  2. The Parties agree that Christian Mediation and Christian Arbitration shall be the sole remedies for any dispute, controversy, or claim against TMBC, and Parties expressly waive their right to file a lawsuit against one another in any court for such disputes, except to enforce a legally binding arbitration decision.
  3. Therefore, any Party with a claim or dispute against TMBC, including claims under federal, state, and local statutory or common law, shall first attempt to settle the claim or dispute through biblically based Christian Mediation.
  4. If the complaining Party desires to pursue Christian Mediation, the complaining Party shall notify TMBC in writing within sixty (60) days of the event or action giving rise to the dispute, controversy, or claim against TMBC. Within sixty (60) days of such notice, TMBC representatives and complaining Party shall meet at an agreed upon location with a Christian Mediator, mutually agreed upon by both Parties, to attempt to resolve the dispute in good faith. Should the dispute not be resolved through Christian Mediation, the complaining Party may seek remedies exclusively through Binding Arbitration.

Process for Binding Arbitration

  1. If Christian Mediation does not resolve the dispute between the Parties, the Parties shall then submit the matter to an independent and objective Arbitrator for Binding Arbitration. The Parties agree the Binding Arbitration process will be conducted in accordance with the aforementioned Scriptural principles.
  2. If the complaining Party desires to pursue Binding Arbitration after Christian Mediation fails to resolve the dispute, the complaining Party shall notify TMBC in writing within sixty (60) days after the end of the Christian Mediation process of the Party’s desire to pursue Binding Arbitration.
  3. After Notice is given to TMBC, Binding Arbitration shall occur within a reasonable time, mutually agreed upon by both parties, not to exceed two (2) years from when the complaining Party knew or should have known of the controversy, claim, dispute or breach.
  4. It is the intent of the parties that, barring extraordinary circumstances, Binding Arbitration proceedings shall be concluded within one hundred and twenty (120) days from the date the arbitrator or arbitrators are appointed.
  5. This agreement for Binding Arbitration shall be specifically enforceable. A Party may apply to any court with jurisdiction for relief, including a proceeding to compel arbitration.
  6. The arbitration shall be conducted by one arbitrator. If the Parties are not able to agree upon the selection of a single arbitrator within thirty (30) days of commencement of the arbitration, the arbitration shall be conducted by three (3) arbitrators. If three arbitrators are required due to the failure to select a single arbitrator, each Party shall select one arbitrator within twenty (20) days of the failure to select a single arbitrator. The two arbitrators selected by the Parties shall then select a third neutral arbitrator within twenty (20) days of their selection.
  7. The arbitration shall be conducted at a location within 25 miles of the physical address of TMBC.
  8. The laws of the State of California shall be applied in any arbitration proceedings, without regard to principles of conflict of laws.
  9. Except as may be required by law, neither Party nor its representatives may disclose the existence, content, or results of any arbitration hereunder without the prior written consent of all Parties.
  10. The Parties shall be entitled to discovery in the arbitration. Parties, however, shall be entitled to request no more than five hundred (500) pages of documents for the opposing Party. Each Party shall take no more than three (3) depositions of opposing Party not to exceed eight (8) hours for each such deposition. Each Party shall be entitled to depose any expert who will testify in the arbitration proceeding but shall pay the regular hourly rate of such expert during such deposition. In addition to the foregoing, any Party shall be entitled to take the deposition of a witness, who is not a Party member, who will testify at the arbitration, but who is unavailable to testify at the hearing to preserve such witness’ testimony for the arbitration hearing.
  11. The Parties shall exchange a copy of all exhibits for the arbitration hearing and shall identify each witness who will testify at the arbitration, with a summary of the anticipated testimony of such witness, ten (10) days before the arbitration hearing.
  12. Arbitrators shall have no authority to award punitive, exemplary, or related types of damages. Arbitrators shall not be entitled to issue injunctive and other equitable relief.
  13. The cost of the arbitration proceeding and any proceeding in court to confirm or to vacate any arbitration award, including reasonable attorneys’ fees and costs, shall be borne by the unsuccessful party, as determined by the arbitrators, and shall be awarded as part of the arbitrator’s award. It is specifically understood and agreed that any party may enforce any award rendered pursuant to the arbitration provisions of this Section by bringing suit in any court of competent jurisdiction. This Section shall survive the termination or cancellation of this Agreement.
  14. Each party shall pay its own proportionate share of arbitrator fees and expenses plus the fees and expenses of the arbitrator it designated if there are three arbitrators. The arbitrators shall be entitled to award arbitration and administrative fees and expenses as damages in his/her discretion.