ASSUMPTION OF RISK AND RELEASE OF LIABILITY AGREEMENT
AUTHORIZATION FOR MEDICAL TREATMENT OF A MINOR AGREEMENT
MEDICATION AUTHORIZATION AND RELEASE AGREEMENT
WHEREAS, THE UNDERSIGNED (the applicant) wishes to be accepted for participation in all activities conducted by GOD IS GOOD MINISTRIES OF DALLAS, INC. (hereafter called “GIG”). In consideration of, and for the right to participate in such activity by GIG, its Directors, Officers, Trustees, Employees, Agents, and/or Associate, I have and do hereby assume all of the risks and any other ordinary risk incidental to the nature of the activity.
Further I will hold GIG, its Directors, Officers, Trustees, Employees, Agents, and/or Associate harmless from any and all liability, actions, causes of action, debts, claims, and demands of every kind and nature whatsoever, whether for bodily injury, property damage or loss, medical bills, hospital bills, and doctor bills, or otherwise, which the participant now has or which may arise from or in connection with participation in any activities arranged for me by GIG, its Directors, Officers, Trustees, Employees, Agents, and/or Associates, and their heirs, executors, and administrators, successors and assigns and for all members of my family, including any minors accompanying me. I fully understand that my physical activity involves risk of injury. I also understand that my participation in any activity is entirely VOLUNTARY. I enter into this activity and take full responsibility for the decision to participate or not to participate and agree to follow all safety instructions.
I do hereby release GIG, its Directors, Officers, Trustees, Employees, Agents, and/or Associate any liability whatsoever (including acts of negligence) arising out of an injury, damage, death, or loss, whether physical, mental or emotional, which may be sustained to the applicant, during the course of applicant’s involvement with this camp or any overnight camping before the camp session or after the camp session. I consent to the use and display of photographs (possibly on the internet) of the applicant.
I hereby agree that all health history is correct and complete as far as I know and the person herein described has permission to engage in all camp activities except as noted. I understand that applicant may be sent home if Camp rules are not followed.
Medications: I give permission to camp staff to administer "over-the-counter" medications and/or prescription medications (listed above, or prescribed during camp) to the applicant. I give authority and consent for GIG to treat applicant for a headache, fever, or upset stomach with the appropriate non-prescription medication such as Ibuprofen, Acetaminophen and Pepto-Bismol.
Emergency Medical Authorization: I consent for emergency medical treatment to be administered to the applicant by a licensed Physician, Nurse, Adult Staff Member or other emergency medical personnel. I hereby give permission to medical personnel to order X-rays, routine tests, and treatment for applicant. I hereby give permission to the Physician to hospitalize, secure proper treatment, order injections and/or anesthesia and/or surgery. I hereby authorize transportation to a medical facility by ambulance or other transportation if it is deemed necessary.
I further authorize the release of the above medical information to appropriate medical personnel and/or the health coverage insurance company. I agree that I am responsible for all medical expenses incurred in the event of a sickness and/or injury.
Background Investigation: I hereby authorize GIG to investigate applicant’s background and qualifications for purposes of evaluating whether applicant is suitable for the staff position. I understand that GIG may or may not utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and the application will not be processed further.