Princeton Christian Reformed Church Permission/waiver Form printable pdf download

Date ______________

Consent to participate in:

______________________________________________

Cadets_____ GEMS_____ PYG_____ Other ______

Princeton Christian Reformed Church

Consent and Medical Release Form

Participant (please print):___________________________________________________

Parent(s) and/or legal guardian(s) (if minor):____________________________________

Address:________________________________________________________________

Home/Cell Phone: (___)_________________ Work Phone: (___)___________________

DOB:___________ Academic Grade:_______

Church:__________________________________________________

Functions and Activities

I understand that participating in the programs and activities of Princeton Church is a privilege. Prior to

participation in such activities, I acknowledge that there are certain risks associated with the activities,

including, for example, physical injury due to activity-related accidents, and physical injury due to

transportation-related accidents, illness, or even death. In addition, I acknowledge, and assume the

responsibility for any other risks inherent in these activities of which we may not be presently aware.

Release of Liability

By signing this Consent/Medical Release Form, I expressly warrant that the child named above is capable

of withstanding both the physical and mental demands of the activities discussed above. I also expressly

assume all risks of my child participating in the activities, whether such risks are known or unknown at

this time. I further release Princeton Church and its administrators, leaders, employees, and volunteers

from any claim that we or our child might have against them as a result of an injury or illness incurred

during the course of participation in the activities or transportation to or from such activities. This release

of liability shall include (without limitation) any claims of negligence or breach of warranty. This release

of liability is also intended to cover all claims that members of the child’s or my family or estate, heirs,

representatives, or assigns may have against Princeton Church or its administrators, leaders, employees,

and volunteers.

I further agree to indemnify, defend and hold harmless Princeton Church and its administrators, leaders,

employees, and volunteers from any and all claims arising from my participation or my child’s

participation in its activities and programs, including transportation to or from such activity, or as a result

of injury or illness of my child or me during such activities.

First Aid and Emergency Medical Treatment

I recognize that there may be occasions where the child named above may be in need of first aid or

emergency medical treatment as a result of accident, illness, or other health condition or injury. I do

hereby give consent for representatives of Princeton Christian Reformed Church or designated

representatives to seek and secure any needed medical attention or treatment for the child named above or

me, if I am a participant, including hospitalization, if in the representative’s opinion such need arises.

Thus I agree to pay all fees and costs arising from this action to obtain medical treatment. I give consent

for attending physician(s) and other medical personnel to administer any needed medical treatment,

including surgery and, again, I agree to pay for the medical treatment.

Princeton Christian Reformed Church Permission/waiver Form