I, the undersigned, certify that I am the parent or legal guardian of the “minor child”.
To the fullest extent permitted by law, I release First Assembly of God, its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless First Assembly of God, its trustees, officers, directors, employees, agents and representatives from any claims arising out of my minor child’s participation in the activity.
Further, being the parent or legal guardian of the minor child, I do consent to any medical, surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for my minor child. I understand that efforts will be made to contact me prior to treatment but, in the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child. As parent or legal guardian, I understand that I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for the medical, dental, or hospital care or treatment that is given to my minor child. Any insurance policy of the church or organization sponsoring this event will be used as the secondary coverage.
Please complete the Emergency Contact and Medical Information Section below
Emergency Contact and Medical Information