I, the undersigned, am the parent or legal guardian of the child or youth ("Child") named above.
I give permission for our (my) child, named above to attend and participate in activities sponsored by Northside Christian Church anytime from January 1, 2021 to December 31, 2021. We the undersigned do hereby release, forever discharge and agree to hold harmless Northside Christian Church and the Staff, Elders and Trustees 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 church activities.
We (I) authorized an adult, in whose care the minor has been entrusted, to consent to any x-ray examination, anesthetic, medical, or surgical or dental diagnosis or treatment, and 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 rendered to the aforementioned child pursuant to this authorization.
Should it be necessary for our (my) child to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs.
Furthermore, we (I) hereby assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees and agents, volunteer sponsors and lifegaurds, for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant, including expense incurred attendant thereto.
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 Northside Christian Church.