Cccsb T.g.i.f. Power Club Application Form (Page 2 of 4) in pdf

Cccsb T.g.i.f. Power Club Application Form Page 2

WAIVER of LIABILITY/PERMISSION SLIP

I, the undersigned, give my full consent that I or my child__________________ am/are willing

to participate in the events or activities held by or at the Chinese Community Church of South

Bay.

And I or we agree not to hold Chinese Community Church of South Bay, including but not

limited to its Board of Deacons, officers, church staff, employees, members, volunteers and other

supporting personnel responsible for any injuries or harm occurring during such events for as

long as I or my child willfully participate in such events or activities which including the needed

transportation arrangement; and release any liability that I, my heirs, executors, trustees,

personal or legal representatives and all members of my family, may now have or in the future

make against such parties as a result of or related to any injury, loss, death or damage of any kind

whatsoever resulting from such activities.

In the event of any possible medical emergencies, I, undersigned give full consent for the

administration of any emergency medical treatment deemed necessary by a consulting physician

chosen by Chinese Community Church of south Bay personnel acting for the benefit of the

undersigned or my child.

This authorization will remain effective while the above name/minor is en route to or from or

involved or participating in the events or activities held by or at the Chinese Community Church

of South Bay.

Print Name

Signature

Date

Address

Home phone

Cell phone

Email address

Emergency contact Information

Student A greement

Cccsb T.g.i.f. Power Club Application Form Page 2