The child named above is in good health and has no physical or medical limitations that would cause the activities/outing as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section above.

I hereby consent to any x-rays, anesthetic, medical, surgical, or dental diagnosis or treatment that may be deemed necessary for my minor child. In the event I cannot be reached in an emergency, I give permission to the activity leader(s) to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat  my child. I understand that the doctors, dentists, and other providers attending to my child will take all reasonable safety precautions during their care. Further, as parents or legal guardians I hereby agree that I am financially responsible, either personally or through my health insurance plan, for any dental, medical, or hospital care or treatment that is given to my child.

I/We understand that Mt Zion A/G does not carry any insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my own insurance carrier; or (b) that I/We am personally financially responsible for any and all medical costs incurred as a result of the child's injury.

I understand that promotional pictures (individual and group) have been / will be taken during these events. I give permission for my son’s/daughter’s picture, video & audio to be used for promotional materials (social media, web page, calendars, power point, video clips, etc.) in highlighting the event. NAMES WILL NOT BE USED

If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to and authorize the above-named activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).

If, in the event of a medical or other emergency, I am unable to be reached by telephone at my home or work telephone numbers listed below, I authorize the activity supervisor(s) to attempt to contact me through the emergency contacts listed below.