For July 15, 2019 to August 31, 2020
Functions and Activities:
It is my understanding that participating in the programs, recreational and other activities of Rockland Memorial Community Church is a privilege. Prior to my child’s participation in such activities, I acknowledge that there are certain risks associated with the activities including, by way of example and not limitation, physical injury, 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.
Release and Liability:
By signing this Waiver Form, I expressly warrant that the child/children named above is/are capable of withstanding the physical demands of the activities discussed above. I also expressly assume all risks of the child or me participating in the activities, whether such risks are known or unknown to me at this time. I further release Rockland Memorial Community Church and its ministers, leaders, employees, volunteers, or agents from all liabilities arising out of participation in these programs. I further agree to indemnify and hold harmless Rockland Memorial Community Church and its ministers, leaders, employees, volunteers and agents from any and all claims arising from my participation in its activities and programs, or as a result or injury, illness or death of my child during such activities. First Aid and Emergency Medical Treatment: I recognize that there may be occasions where I or the child named above may be in need of first aid or medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of Rockland Memorial Community Church to seek and secure any medical attention or treatment for me and the child named above, including hospitalization, if in the minister’s, leader’s, employee’s volunteer’s or agent’s opinion such need arises. I agree to pay all fees and costs arising from the action to obtain medical treatment. I give permission for attending physicians(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment. Special Events and Activities: I understand that the child/children named above will be participating in various activities from July 15, 2019 to August 31, 2020. I understand that during this period my child may take part in activities such as Sunday school, youth group, mission trips, retreats, family camp and other activities consistent with the purposes of the church. I also understand that I may be asked to sign Special Permission Slips in addition to this form.
On occasion, Rockland Memorial Community Church takes photographs or makes an audio or video tape 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 or participants. In addition, such photographs and audio/visual recordings may be used in Rockland Memorial Community Church publications or advertising materials to let others know about our ministry. I consent to the use of any such audio or visual record of me and the child/children 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, and audio recordings.
Optional: Please list important medical history, special medical needs or concerns, medications, allergies, dietary needs, conditions and/or other information that leaders should know about your child/children:
I represent that I am the parent/ guardian of the child/children listed above. I have read the above Permission/Waiver Form of Rockland Memorial Community Church, including any special events/activities described above. In consideration for allowing the participation of the child in the activities of Rockland Memorial Community Church, I hereby consent to this Waiver Form, including the Release of Liability above, on behalf of the child/children and me, and agree that this Waiver Form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns. I also understand that it is my responsibility to see that the information on this form is updated.
By typing in my/our name(s) below, I am fully aware that I am digitally signing my/our name(s):
All information on this form will be kept confidential, and will not be given out for any reason without the consent of the parent or guardian.