Church Summer Camps

Before my child participates in the summer camps hosted by the church, I acknowledge that certain risks are associated with these activities including: injury due to activity-related accidents, physical injury due to transportation-related accidents, illness or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware of. After having been fully informed of this inherent and possible risk, the undersigned hereby give our consent to and authorize the child named above to participate in all events conducted by the Church. 

 

FIRST AID AND EMERGENCY MEDICAL TREATMENT

I recognize that there may be occasions where my child may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of the Church to seek and secure any needed medical attention or treatment for the child named including hospitalization if in the opinion of the agent such a need arises. Further, I authorize the agent of the Church to consent to any medications, examinations, and other procedures that may be deemed necessary for the well-being of my child by a licensed medical practitioner in accordance with the existing laws of the state.

 

STATEMENT ON PUBLICITY

The Church takes photographs or makes audio or videotape recordings of children and/or adults involved in church activities. Such photographs or video records may be used by the Church through its staff for remembrance as well as publications or advertising materials, local news, and other uses that the Church may deem beneficial. If you give your consent, you are permitting the Church to use any such audio or visual record of your child for the purposes mentioned above. This consent includes but is not limited to:  photographs, videotape, audio recordings, and the Church’s web page.

 

RELEASE OF LIABILITY

By completing and signing this document, you assume and accept all risks and hazards inherent in Church-related programs, outings, and social activities and to release the Church, its employees, board, agents, volunteer assistants, and other persons or entities, including other participants, from any and all liability for damages, losses or injuries to the person or property of the undersigned. Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.

 

PARENT OR GUARDIAN SIGNATURE

 I represent that I am the parent/guardian of %child_first_name% %child_last_name%, who is under 18 years of age. I have read the above form and am fully aware of the contents thereof. I give permission for the child named above to participate in the activities of the church. In consideration for allowing the participation of the child in the activities of the Church, I hereby consent to the above terms on behalf of the child and agree that this form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns.

Options

I do not give my consent for the following activities (Please specify such situations that your child may not participate.)

Please list activities that you do NOT want your child to do

Please list special medical needs or concerns (allergies, conditions, dietary needs, medications, etc.)

Health Insurance Company

Health Insurance Company Phone Number

Health Insurance Company Policy Number

Medical Doctor’s Name

Doctor’s Phone Number

Is Tetanus Shot Current? Y / N

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