I, the above signed parent/guardian of the minor child/children listed on this form, do hereby give permission for them to attend and be involved in all activities of VBS at the Dalkena Community Church, (hereafter DCC) at 425961 HWY 20, Newport, WA on the following dates: Monday-Friday June 22-26th. I understand that DCC and its representatives will make a reasonable effort to provide a safe environment, however. I am aware that there are certain risks inherent in participating in this activity. In the event of an accident or illness, I understand that reasonable effort will be made to contact the Parent or Guardian immediately. However, if not available, I authorize DCC's representatives to secure emergency medical care as needed. I agree and consent to having the ministers, staff members, volunteers and leaders under whose auspices the program is conducted and any other worker in the program to secure any emergency medical care or treatment that may be necessary for above named participant(s) during the dates listed above. I hereby further assume all responsibility for the decisions made regarding emergency medical care or treatment secured for the named participant(s) in the event that I cannot be reached.
Your typed name constitutes a valid signature
I, the above signed parent/guardian of the minor child/children listed on this form, do hereby authorize adult workers with the youth of Dalkena Community Church, Newport, WA, as agents of the undersigned, to consent to any examination, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care which is rendered under supervision of any physician or surgeon licensed under provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis of treatment is rendered at the office of said physician or at said hospital in the event I cannot be reached.
Your typed name constitutes a valid signature
I, the above signed parent/guardian of the minor child/children listed on this form, do hereby fully and knowledgeably release Dalkena Community Church, Newport, WA, a religious corporation of the state of Washington, its Trustees, members of the Board, and any adult leaders, whether volunteer or professional, from all liability for any accident, injury, or death caused to the named minor person(s) that may result from any athletic, recreational, social, or any activity sponsored by or participated in by said religious corporation, and that this Waiver of Liability shall bind heirs, executors, administrators, assigns, and/or other persons having control over the affairs of said minor person.
Your typed name constitutes a valid signature
