Adult Medical Release Form

I hereby give my permission, for myself, to participate in an activity organized by Kennesaw Methodist Church (Kennesaw MC). I hereby release, hold harmless and absolve Kennesaw MC, their officers, staff, sponsors, vendors and all others who have participated in the planning, organizing, and implementing of the activity, be they individuals or organizations, singly or collectively, from responsibility and liability for any illness, injury, misadventure, harm, loss or inconvenience suffered or sustained as a result of the participation in the activity. I understand that in the event I or my child requires medical treatment while engaged in the activity, reasonable efforts will be made to contact my designated emergency contacts; however, if they cannot be reached, I hereby consent and give my permission to the Kennesaw MC staff or any adult counselor acting on behalf of Kennesaw MC with respect to the activity, to consent to any X-ray examination, medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate} licensed to practice under the laws of the state where the services are rendered, either as an outpatient or in any hospital. To the best of my knowledge, I have listed above all of my medical allergies, medications being taken, medical problems and other pertinent information. Finally, I agree that Kennesaw MC may tape or photograph me and record my Voice during their participation in the activity. I agree that Kennesaw MC will be able to use them, in whole or in part. whether In original or modified form in any manner or media, Including without limitation, for the purpose of advertising, promoting, and publishing the Kennesaw UMC whether doing the activity or thereafter. I hereby release and discharge Kennesaw UMC and an affiliated entities from any and all claims, demands, or causes of action that I shall in connection with the use and exercise of the rights granted in this release.