Crooked Creek Baptist Church
Permission Form
Kings Island Trip
Monday, July 17
Starting time: 7:30 a.m.
Ending time: 12 midnight
I,
_____________________________ am the parent or legal guardian of
__________________________
born
on ________________, 19___. I warrant that I possess all the rights, powers,
and privileges of a
parent
or legal guardian necessary to execute this document with binding legal effect.
As
the parent or legal guardian of ____________________________, I certify and
affirm that I have been
completely
and thoroughly informed that as a child attending Kings
Island,
my child
will
participate in certain activities which carry with them a degree of risk and
danger. I acknowledge and
understand
that Crooked Creek Baptist may offer other activities not listed above that
present
similar
risks or dangers to my child. I consent to my child’s participation in these
activities. I acknowledge
and
understand that this PARENTAL AUTHORIZATION, CONSENT AND RELEASE has the same
force
and effect regardless of whether the activities engaged in are free or if a fee
is charged. Further, I
personally
assume, on my child’s behalf, all risk in connection with said activities for
any harm, injury or
damages
that may befall my child as a result of my child’s participation in the
activities, whether foreseen
or
unforeseen, and I still wish to allow my child to proceed with the activities.
In
consideration of my child being allowed to participate in these activities and
to use
Crooked
Creek Baptist equipment and facilities, on behalf of my child, I hereby
voluntarily
release,
forever discharge, and agree to indemnify and hold harmless Crooked
Creek
Baptist
Church,
from
any and all claims, demands, or causes of action, which are in any way
connected with my child’s
participation
in these activities or use of Kings
Island,
equipment and facilities.
I
understand that it is my obligation to inform the church of any and all health
considerations or medical
conditions
that would restrict my child’s participation in any and all activities while in
the care of
Crooked
Creek Baptist Chaperones. Should the need for medical attention arise the
church will attempt to
contact
me as soon as practicable under the circumstances.
In
cases of emergency, I further consent to the examination or treatment of my
child by a physician duly
licensed
to practice medicine in the United
States of America
or any health care professional duly licensed
to
provide heath care serviced in the United
States of America
for medical care and services deemed
necessary
by the doctor, its agents, servants, and employees. I give permission to the
doctor or health care
professional
to provide any and all medical care they deem, in their professional opinion,
to be necessary. I
agree
to pay for any and all medical expenses incurred as a result of the use of this
consent.
I
acknowledge by signing this document, that if anyone is hurt or property is
damaged during my child’s
participation
in these activities, I may be found by a court of law to have waived my right to
maintain a
lawsuit
against the church on the basis of any claim form which I have released them
herein. I agree that if
any
portion of this agreement is found to be void or unenforceable, the remaining
portions remain in full
force
and effect. I have fully informed myself to the contents of this PARENTAL
AUTHORIZATION,
CONSENT
AND RELEASE by reading it before I signed it.
______________________________________
____________________________ _______________
Signature
Printed Name
Date
Contact
Number in case of an emergency ______________________________________
