Permission & Medical Release / Release and Waiver of Liability and Indemnity Agreement
I, the undersigned, being a parent/legal guardian of above named participant, give my permission for the above named participant (hereinafter referred to as “Participant”) to participate in various programs, events, or activates (hereinafter collectively referred to as “Activates”) operated or sponsored by Prescott Christian Church (hereinafter referred to as “PCC”).
I understand that the above the participant is responsible for knowing the rules and regulations, of activities made by PCC staff and sponsors.
I hereby authorize an adult leader of PCC to take the participant to a medical doctor for examination and treatment of any accident or illness that may arise while on a PCC sponsored activity. I understand that in the event of a medical emergency, every effort will be made to contact the parent/guardian listed. In the event I cannot be reached, I hereby authorize any physician, nurse, medical authority and/or hospital to administer proper treatment to the participant.
In consideration of being permitted to participate in PCC operated or sponsored activities, I, the undersigned, on behave of the participant, hereby releases, waives, discharges and covenants not to sue PCC, it’s officers, directors, agents, employees, and volunteers, from liability for any and all claims including the negligence of PCC, it’s officers, directors, agents, employees, and volunteers resulting in illness, bodily damage, personal injury (including death) and property loss arising from participation in PCC operated or sponsored activates.
I, the undersigned, on behave of the participant, hereby agrees to indemnify and save and hold harmless PCC, it’s officers, directors, agents, employees, and volunteers, from any loss, liability, damage, or cost that may incur due to the participant’s participation in PCC operated or sponsored activates.
The undersigned, on behalf of above named participant grants Prescott Christian Church to use the above named participant’s photograph or likeness in any promotional material or future publications to represent Prescott Christian Church. The undersigned acknowledges and agrees the undersigned or the above participant will not be entitled to compensation for such use.
I, the undersigned, further expressly agrees that this authorization and agreement is intended to be as broad and inclusive as is permitted by the law of the state of Arizona and that if any portion thereof is held invalid, it is agrees that the balance shall notwithstanding, continue in full legal force and effect.
I, the undersigned, on behalf of the participant, have read and voluntarily signed this authorization and agreement, and further agrees that no oral representations, statement or inducement apart from the forgoing written agreement has been made.
I, the undersigned, on behalf of the participant, agree to notify PCC leadership of any changes to the information provided on the release/agreement.
This authorization shall remain effective through unless sooner revoked in writing and delivered to said agents.
Dated: January 22, 2019