Preferably not a parent listed above. All efforts will be made to contact the parents first in the event of an emergency. If in the event we are unable to reach either of the parents listed above we will contact the person below.
Please list any allergies, medical conditions, dietary restrictions, medications that will need to be administered etc.
Activity: ALL ACTIVITIES AND / OR EVENTS SPONSORED BY EUTO BAPTIST CHURCH AND / OR EUTO BAPTIST CHURCH STUDENT MINISTRIES RANGING FROM THE DATE SIGNED - TO ONE CALENDAR YEAR LATER. This form waiver is valid for one calendar year.
I/We acknowledge that my child/children will participate on this activity with Euto Baptist Church / Euto Baptist Church Student Ministries. Therefore, in consideration of my child/children being allowed to participate, I/We agree to the following:
I hereby take the following action for my child/children:
I waive, release, remise and forever discharge from any and all claims, demands, actions or cause of action for death or personal injury, damages of any kind which arise out of or relate to my child’s participation on this activity, the following persons or entities: Euto Baptist Church of Marshville, NC, its Senior Pastor, Student/Youth Pastor, Staff, Interns, chaperons and volunteers.
I authorize any licensed physical, emergency medical technician, hospital or other medical or health care facility to treat the minor/minors named herein for the purpose of attempting to treat or relieve any injury received by said minor. I authorize any such medical provider to perform all procedures deemed medically advisable in attempting to treat or relieve any such injuries. I consent to the administration of anesthesia as deemed advisable. I realize and appreciate that there is a possibility of complications and unforeseen consequences in any medical treatment, and I assume any such risk for and on behalf of myself and said minor. I understand that attempts will be made to contact me in the most expeditious way possible. Permission is also granted to Euto Baptist Church representatives to provide the needed emergency treatment to the student prior to his/her admission to a medical facility.While away from the Euto Baptist Church campus, all students are under the responsibility of the chaperones/leaders on this any trip. Failure in obeying and respecting the leaders will result in the teenager returning home to the parents. Some specific reasons for being sent home will be possessing alcohol, illegal drugs, or possession of a weapon. It will be the responsibility of the parents to provide a way home for their child. Parents agree to allow the chaperones/leaders to make the final decisions about sending a student home.
ELECTRONIC SIGNATURE CONSENT
You are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. You consent to be legally bound by this Agreement's terms and conditions.