Waiver & Release of Liability
Functions & Activities
Prior to my child’s/children’s participation in the programs and events/activities of Grace United OPC ("the Church"), I acknowledge that certain risks are associated with these activities, including, by way of example, physical 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. By initialing below, I hereby give my consent to and authorize the child(ren) named above to participate in all events conducted by the Church. I further authorize my child to travel with representatives of the Church in private or other vehicles to any such
events so conducted. Note: If you desire to limit your child’s participation in any event, please inform the Church in writing in advance of that event.
Medical Treatment Authorization
By initialing below, I hereby consent to and authorize the following: I recognize that there may be occasions where the child/children named above 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/children 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 X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is rendered under the general or special supervision of, any physician, surgeon, or dentist licensed under the laws of the State or County in which the medical care is being sought and on medical staff of any hospital. In doing so I agree to pay all fees and costs arising from this action to obtain medical treatment including any treatment a physician, surgeon, or dentist may deem necessary. It is understood that this authorization is given in advance of any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care being required but is given to provide authority and power on the part of the agent to give specific consent to any and all such examination, anesthetic, diagnosis, treatment, or hospital care which the aforementioned physician, surgeon and/or dentist, in the exercise of his/her best judgment, may deem advisable. I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of the child to the agent upon the completion of treatment.
Release of Liability
By initialing below, this form constitutes agreement by the parent/guardian to assume and accept all risks and hazards inherent in Church related programs, outings, and social activities and to release the Church, it’s 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.
