By marking Agree in the box below, I grant this permission and certify the statements and information provided in items 1-8 that appear below.
1. General Permission:
I understand and agree that this event is sponsored by Good News FWB Church Ministries and depending upon circumstances, and without limitation, may involve both:
(a) spiritual or religious activities, such as Christian living or education classes, religious worship services, and the like.
(b) transportation of children by teachers or bus/van drivers to and from the event location and I give my permission for my child to engage in all such activities.
2. Acceptance of Event Conditions:
I understand and agree to the condition of the event venue as described in the information provided. I give permission for my child to participate under these conditions.
3. Disclosure of Special Health Conditions: The following is a list of my child's special health conditions and needs of which event staff need to be aware. (List here such things as medication, history of seizures, motion sickness, allergies, etc.)
4. Release of Liability Regarding Special Health Conditions:
I submit that the above mentioned special health conditions and instructions are needed for my child while at the event. I understand that, although event personnel will seek to help accommodate these special conditions, such as by giving medications and/or by seeking to take appropriate precautions, etc., nonetheless, by sending my child to the event with these special health conditions:
(a) I acknowledge that I understand the event is not equipped to monitor or supervise such special conditions or needs as would the parent if he/she were present.
(b) I certify it is safe for my child to participate in all event activities notwithstanding the special conditions , and notwithstanding and possible lapse in medication, or possible interaction with other people or circumstances that may affect the special conditions.
(c) I release and indemnify the event from all claims and liabilities stemming from special conditions, including, without limitation, any claim, illness, or injury, resulting from the event's failure to properly administer medicines for the special conditions, failure to recognize a situation which might be potentially harmful to a person with the special conditions, or failure to recognize the onset of an episode of the special conditions.
5. Permission to Secure Emergency Services:
I give permission to event staff to secure usual and customary medical and/or legal services for my child if needed in an emergency circumstance at the event. I as parent/guardian will be responsible for the costs of such services if not covered by my insurance.
6. Insurance Coverage: I have filled out my child's insurance information below. I understand that if my child does not have health/accident/medical insurance coverage, I will be responsible for the payment of all expenses which may be incurred due to treatment at the event of an illness or injury.
7. I will assist in maintaining a good environment for club meetings by monitoring my child's health and keeping them home when they show signs of sickness and especially when showing signs of fever.
8. Emergency Contacts:
During the event, I may be contacted as follows:
1. Name of Parent/Guardian Emergency Contact *
2. Name of Parent/Guardian Emergency Contact *
