BY CLICKING THE BUTTON BELOW AND SUBMITTING THIS FORM. I AGREE TO THE BELOW CONDITIONS
1. PERMISSION TO PARTICIPATE: I AM THE PARENT OR GUARDIAN OF THE ABOVE LISTED MINOR(S) AND I GIVE PERMISSION FOR HIM/HER/THEM TO PARTICIPATE IN VACATION BIBLE SCHOOL (VBS) ACTIVITIES AND BE UNDER THE CARE AND SUPERVISION OF EMPLOYEES AND VOLUNTEERS AT ST. MARY’S COPTIC CHURCH FROM JUNE 24 THROUGH JUNE 28, 2019.
2. LIABILITY RELEASE: IN CONSIDERATION OF ST. MARY’S COPTIC CHURCH ALLOWING THE ABOVE MINOR(S) TO PARTICIPATE IN VBS, I DO HEREBY RELEASE, FOREVER DISCHARGE AND AGREE TO HOLD HARMLESS ST. MARY’S COPTIC CHURCH, ITS DIRECTORS, EMPLOYEES, VOLUNTEERS AND AGENTS (COLLECTIVELY HEREIN THE “CHURCH”) FROM ANY AND ALL LIABILITY, CLAIMS OR DEMANDS FOR ACCIDENTAL PERSONAL INJURY, SICKNESS OR DEATH, AS WELL AS PROPERTY DAMAGE AND EXPENSES, OF ANY NATURE WHATSOEVER WHICH MAY BE INCURRED BY THE UNDERSIGNED AND THE ABOVE MINOR(S) WHILE INVOLVED IN VBS.
3. MEDIA RELEASE: I GIVE PERMISSION FOR THE CHURCH TO PHOTOGRAPH, VIDEOTAPE AND/OR VOICE-TAPE MY MINOR(S) FOR PURPOSES OF IN-HOUSE CHURCH USE AND/OR FOR PUBLIC INFORMATION OR PROMOTION OF THE CHURCH (I.E., BROCHURES, WEBSITE), AND/OR FOR SOCIAL MEDIA POSTING. NO SUCH USE OF THESE IMAGES OR RECORDINGS WILL IDENTIFY THE NAME OR OTHER PERSONAL INFORMATION OF THE MINOR(S).
4. MEDICAL TREATMENT PERMISSION: IN THE EVENT OF AN EMERGENCY, I AUTHORIZE AN ADULT IN WHOSE CARE THE ABOVE NAMED MINOR(S) HAS/HAVE BEEN ENTRUSTED AT THE CHURCH DURING VBS TO CONSENT TO ANY EMERGENCY X-RAY, EXAMINATION, ANESTHETIC, MEDICAL, SURGICAL OR DENTAL DIAGNOSIS OR TREATMENT AND HOSPITAL CARE TO BE RENDERED TO THE MINOR(S) UNDER THE GENERAL OR SPECIAL SUPERVISION AND ON THE ADVICE OF ANY PHYSICIAN OR DENTIST LICENSED UNDER THE PROVISIONS OF THE MEDICAL PRACTICE ACT ON THE MEDICAL STAFF OF A LICENSED HOSPITAL OR EMERGENCY CARE FACILITY. THE UNDERSIGNED SHALL BE LIABLE AND AGREE(S) TO PAY ALL COSTS AND EXPENSES INCURRED IN CONNECTION WITH SUCH MEDICAL AND DENTAL SERVICES RENDERED TO THE AFOREMENTIONED MINOR(S) PURSUANT TO THIS AUTHORIZATION