Child/youth Medical Release Form (Page 2 of 2) in pdf

Child/youth Medical Release Form Page 2

LIABILITY RELEASE AND

INDEMNITYFORM

(To

completed by parent of participant)

FIRST PRESBYTERIAN CHURCH

1028 Mesquite, Texas 75149

(972) 285-5602

the undersigned parent or guardian of

,a participant in the programs of

First Presbyterian Church of Mesquite, do hereby agree to the fullest extent permitted by law (including releasing and

indemnifying any negligent acts) to release and hold harmless the First Presbyterian Church of Mesquite, and their

respective ministers

elders, trustees, staff persons, members, volunteers and other participants, whether actively

all

participating in any activity or otherwise from any and

liabilities attendant to or arising from my child's attendance at

or participation in the programs of First Presbyterian Church . I a m aware that these programs may-involve motor travel

in a rented vehicle, or in cars owned by members, within Mesquite, or between Mesquite and other

destinations.

I give

permission for

child to participate in trips sponsored by First Presbyterian

Church.

Signature of Parent or Legal Guardian____________________________________ Date_________________

Signature of Parent or Legal Guardian

_ _ _ _ _ _ _ _

_ _ _

Executed before me this

day of __________________________ in the year of __

______

State of

County of

My Commission Expires

Notary

Public,

State of Texas

(Please complete both sides of this form)

Revised 2015

Child/youth Medical Release Form Page 2