Please provide an emergency contact outside of the home in case parent cannot be reached
First Aid and Emergency Medical Treatment
Due to the nature of this activity (bounce house/obstacle course), I recognize that there may be an occasion where the student(s) 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 hearby give permission for agents of Countryside Christian Church to seek and secure any needed medical attention or treatment for the student(s) named above, including hospitalization, if in the agent's opinion such need arises. In doing so, I agree to pay all fees and costs arising from this medical treatment. I also give permission for attending physician(s) and other medical personnel to administer any needed medical treatment and again, I agree to pay for the medical treatment.
I acknowledge and understand there are inherent risks associated with some Countryside Christian Church activities. I will assume the risks associated therewith, whether known or unknown to me at this time. I recognize that my student's attendance at a Countryside Christian Church sponsored event is a privilege and as a consideration for this privilege, I release Countryside Christian Church including it's employees, agents and trustees, from responsibility for my student's accidental physical injury, including death or illness while at a sponsored trip or activity or during travel to and from events. This release is intended to incude all claims made by my family, estate, heirs, personal representatives or assigns.
I hereby grant permission to Countryside Christian Church the right to take, use, reproduce, and/or distribute photographs, films, video, and sound recordings of my student, without compensation or approval of rights, for use in materials created for the purposes of promoting the activites of Countryside Christian Church.
Authorization to Participate
I represent that I am the parent/guardian of the above named student. I give permission for the above named student to participate in this activity. I consent on behalf of the above named student to the Emergency Treatment Authorization and other agreements as indicated above. Furthermore, I understand that my signature below certifies that the information contained herein is accurate and truthful.
*By entering my name in the box about, I am provided my digital signature on this form, and hereby agree to the above terms
