FUNCTIONS AND ACTIVITIES
It is my understanding that participating in the programs and recreational and other activities of La Cañada Presbyterian Church (“the Church”) is a privilege. Prior to my child’s participation in such activities, I acknowledge that certain risks are associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.
The undersigned hereby give our consent to and authorize the minor child named above to participate in all events conducted by the Church. I further authorize my minor child to travel with representatives of the Church in private or other vehicles to any such events so conducted.
On occasion, the Church takes photographs or makes an audio or videotape recording of children and/or adults involved in church activities. Such photographs or video records may be used by staff and participants to remember the activities and participants. In addition, such photographs and audio/visual recordings may be used in La Cañada Presbyterian Church publications or advertising materials to let others know about our ministry. In addition, local news organizations may hear of our activities or events, and our Church may allow them to photograph or record our events for news reporting on special interest features. By signing this form, you consent to the use of any such audio or visual record of the child named above to be used, distributed, or displayed as agents of the church see fit. This consent includes but is not limited to: photographs, videotape, audio recordings, and the Church’s web page.
RELEASE OF LIABILITY
By signing this 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 the child participating in the activities, whether such risks are known or unknown to me at this time. I, the undersigned, for my child, my child’s personal representatives, assigns, heirs, distributees, guardians, and next of kin (“the Releasors”), hereby irrevocably and unconditionally release, waive, discharge, and covenant not to sue the Church and its ministers, leaders, employees, volunteers, and agents, for and from all claims of any nature now or hereafter existing whether known or unknown, including but not limited to, all liability to the Releasors, on account of injury to my child or death to my child or injury to the property of the child, whether caused by the negligence of the Church, its ministers, leaders, employees, volunteers, and agents or otherwise, during the course of my child’s participation in the activities, arising out of or in connection with activities related to the Church, or any travel connected therewith.
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 an accident, illness, or other health condition or injury. I do hereby give permission for agents of the Church to seek and secure any needed medical attention or treatment for the child named including hospitalization, if in the opinion of the agent such a need arises. Further, I authorize the agent of the Church to consent to any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is rendered under the general or special supervision of, any physician, surgeon, or dentist licensed under the laws of the State or County in which the medical care is being sought and on medical staff of any hospital. In doing so I agree to pay all fees and costs arising from this action to obtain medical treatment including any treatment a physician, surgeon, or dentist may deem necessary.
It is understood that this authorization is given in advance of any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care being required but is given to provide authority and power on the part of the agent to give specific consent to any and all such examination, anesthetic, diagnosis, treatment, or hospital care which the aforementioned physician, surgeon and/or dentist, in the exercise of his/her best judgment, may deem advisable. I hereby authorize any hospital which has provided treatment to my child to surrender physical custody of the child to the agent upon the completion of treatment.
Date Signed: December 5, 2022