In consideration for being accepted by Shelby Christian Church for participation in this activity, we (I) being 21 years of age or older, do for ourselves (myself) (and for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless Shelby Christian Church and the directors thereof from any and all liability, claims, or demands for personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the trip or activity. Furthermore, we (I) [and on behalf of our (my) child-participant under the age of 21 years] here-by assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein. Further, authorization and permission is hereby given to Shelby Christian Church to furnish any necessary transportation, food, and lodging for this participant. The undersigned further hereby agree to hold harmless and indemnify Shelby Christian Church, it’s directors, employees, and agents, for any liability sustained by Shelby Christian Church as the result of the negligent, willful or intentional acts of said participant, includeing expenses incurred attendent thereto.
We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and any hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services to be rendered to the aforementioned child pursuant to the authorization. Should it be necessary for our (my) child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs. The undersigned does also hereby give permission for our (my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by Shelby Christian Church.
We (I) are the parent(s) or legal guardians of this participant, and hereby grant our (my) permission for said child to participate fully in said trip. I have read the foregoing and understand the responsibilities and accept these conditions.