It is my desire that my child/ward participate in the activities of Ventura Missionary Church, therefore:
I the undersigned guardian, do hereby authorize the adult sponsor of Ventura Missionary Church or any responsible adult person bearing this written authorization, into whose said care the below mentioned minor child has been entrusted, to obtain proper medical care from a licensed medical or dental doctor or facility. The medical/dental care is to include, but not limited to, any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to said minor under the general or special supervision and upon the advice of a licensed medical doctor or dentist.
It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of said adult person to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician or dentist in the exercise of his best judgment may deem advisable. This authorization shall include transportation to receive the medical or dental care.
It is understood that while participating in activities at Ventura Missionary Church, my child is to follow the guidelines set by the adults in charge. Should my child not cooperate with these guidelines, I agree to pick up him/her from the activity.
In the event of injury to my child/ward I agree that I/we and my health care insurer shall be financially responsible for any medical treatment required by my child/ward as a result of any injury or illness suffered during his/her participation in any church-related activities.
I am aware that these activities may involve some hazards. I have considered these risks, and I still wish my child/ward to participate. Furthermore, I agree not to bring legal action against Ventura Missionary Church, staff or sponsors as a result of any injuries suffered in the course of his/her participation.
In the event a dispute arises between me and Ventura Missionary Church concerning injuries to my child/ward, then I agree that the dispute shall be resolved by a Christian arbitrator acceptable to both sides. The cost of the arbitrator is to be shared equally by the parties. All applicable statutes of limitation shall apply and arbitration must be requested within the appropriate period in order to preserve a right to recovery.
Term of Agreement
This authorization will remain in effect from June 30, 2019 - June 30, 2020 while the minor above is involved or participating in any program or activity authorized by Ventura Missionary Church, unless revoked by the undersigned in writing and delivered to the agent of Ventura Missionary Church.