Together with their respective Officers, Employees and Agents, as well as each volunteer assisting them are collectively designated by the abbreviation “YCI” throughout this entire form, and the term “YCI” shall refer to them individually as well as collectively.
- I (we) hereby authorize YCI to take my (our) child to the undersigned’s designated physician or facility of YCI’s choice for medical treatment in the event of an emergency in which neither parent can be reached after reasonable attempt to reach them. I give permission for my (our) child to attend and participate in ALL activities sponsored by YCI and their ministry partners.
- I (we) hereby authorize YCI and their ministry partners to transport my (our) child to or from church and/or any other church related and sponsored activities and events with church or Volunteer automobile.
- I (we) authorize YCI and their ministry partners to include my (our) child in routinely supervised water, recreational and all other YCI sponsored activities.
- I (we) hereby authorize YCI and their ministry partners to consent to any x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care to be rendered to my (our) child under the general or special supervision and on the advice of any physician or dentist representing to be licensed on the medical staff of a hospital or medical care facility, whether such diagnosis or treatment is rendered at the office of said physician or at the said facility or hospital.
- I (we) hereby authorize YCI and their ministry partners to dispense to my (our) child any over-the-counter medications like Tylenol, Ibuprofen, Antacids, Benadryl. (According to proper dosage instructions)
- I (we) do hereby authorize any physician, dentist, hospital or medical treatment center to treat my (our) child in the case of emergency in which the undersigned’s designated physician or dentist cannot respond.
- The undersigned adult shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. If it is necessary for my (our) child to return home due to medical reasons or otherwise, the undersigned shall assume and be responsible for the payment of all transportation costs.
- I (we) hereby release, forever discharge and agree to defend and hold harmless YCI and its ministry partners, from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever (including negligence) which may be incurred by the undersigned adult and the child/participant that occur while said participant in any trip or activity with YCI and its ministry partners.
- I (we) (and on behalf of my (our) child/) hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation in recreation and work activities involved therein. (The term “all risk” includes, but is not limited to the following: any injury, sickness, death or damages resulting from exposure to outdoor elements such as pond water, snakes, sun, vegetation, insects, etc. or from activities such as creating or operating rope course recreation, mountain biking, paintball, bonfires, kayaking, puddle jumping, hiking, water sports, basketball, football, etc.)
- Further authorization and permission is hereby given to YCI and their ministry partners to furnish any necessary transportation, food, and lodging for my (our) child.
- The undersigned further hereby agrees to hold harmless and indemnify YCI and their ministry partners from and against any claim against or loss incurred by YCI as the result of the negligent, willful or intentional acts of my (our) child, including any expense incurred attendant thereto.
- The medical consent and liability waiver provisions hereof shall remain in full force and in effect until written notice of revocation or withdrawal is received by YCI.I (we) acknowledge and agree that it is my (our) responsibility to notify Youth Commission International of any changes in medical condition, guardianship, address or tele- phone, in writing to the address listed at the beginning of this form.
- I understand that my (our) child may be photographed, filmed, or videotaped at events. I hereby irrevocably grant Youth Commission International, its affiliates, licensees, and collaborators the absolute right and permission to use my child’s likeness and/or voice for any purpose whatsoever.
- This release form is valid for any event, trip, activity, etc. with YCI and their ministry from the date signed until one year later.