Parental/Guardian
Consent, Liabilty Waiver and Medical Consent
Participant's
Name__________________
Parent(s)/Guardian(s)_______________________
Home Phone ______________
Alternate Phone
_______________
Consent & Liability
Waiver
To be filled out by the
Parent/Guardian for youth under 18 years of age.
If participant is 18
years of age or older, consent must be signed by the individual.
I (name of
parent/guardian)____________________________________, grant permission
for my
child,_________________________, to participate in ________________________
to be held _______________,
_________________, and __________________________.
I agree on behalf of myself,
my child's other parent if known or living____________________, my child named
herein, or our heirs, successors, and assigns, to hold harmless and defend
Lebanon Freewill Baptist Church, the sponsoring church (its past, youth leaders,
or other agents, etc.) or any representatives associated with the scheduled
activity.
____________________________________________________________
___________
Signature
(Parent/Guardian)
Date
Medical Consent
In the event of an
emergency, I hereby give permission to transport my child to a hospital for
emergency medical treatment. I wish to be advised prior to any further treatment
by the hospital or doctor.
In the event of an emergency
and you are unable to reach me, contact:
Name & Relationship
__________________________________ Phone ___________________
Family Doctor
____________________________________________
_____________________________________________
___________________________
Signature
(Parent/Guardian)
Date