Authorization to consent to medical treatment of minor child during parents' absence
  • If you would like prefer to fill out and complete a printed form you can download one here.

  • Family Information

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  • For a participate under 18 (below)

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  • Insurance & Health Information

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  • Statement of Agreement

    I, the participant or for those under 18 the parent or legal guardian of the participant listed on this form, hereby consents to his or her full participation in the activities and trips of Southwoods Christian Church. I understand that accidents do happen, and hereby release Southwoods Christian Church and its ministers, directors, youth sponsors, leadership, adult leaders, student leaders, members, and other employees, volunteers, agents and representatives from any liability or other legal or financial responsibility for any negligence (including Southwoods Christian Church’s own negligence) or accidental injury to the above-named participant while he or she is participating in the activities, services, gatherings, events, and trips of Southwoods Christian Church under the supervision of such person(s).In the event of any such accident or other situation in which the above-named participant may require emergency medical or dental care, I hereby authorize any minister, youth sponsor, or other employee, agent, or representative of Southwoods Christian Church, in my absence, to seek out and consent to any necessary medical or dental care for the above named participant; and further authorize any physician, dentist, other medical personnel, or medical or health care facility to rely on such consent and perform any necessary medical or dental care, including, without limitation, x-ray and other diagnostic procedures, administration of anesthetics or medication, and surgery; and hereby ratify and confirm whatever consent to medical or dental care that may be given hereunder. I understand that as a participant I, or my child, may be photographed or videotaped during normal event activities and these photos may be used by Southwoods Christian Church in promotional and other materials. In exchange for Southwoods Christian Church’s consideration in allowing me to participate in activities, services, gatherings, events, and trips of Southwoods Christian Church, I hereby irrevocably grant to Southwoods Christian Church the worldwide, royalty-free, right to use my voice, likeness, photos, and image in all forms and media, and in all manners for any lawful purposes, commercial or non-commercial. I hereby certify that I have carefully read the foregoing and acknowledge that I understand and agree to all the above terms and conditions. I am aware that by signing this agreement I assume all risks including risk of injury, risk of serious injury, loss of limb, and/or death and waive and release certain substantial rights that I may have or possess as to Southwoods Christian Church or any of the covered parties.
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  • Student Code of Conduct (Not necessary for adult participants)

    To be completed by children and students and a parent/guardian and is for the use of all children and student ministry associated events.

  • Students who fail to comply with these expectations may be sent home at their parents' expense.

  • I, the student/child, have read the rules of conduct and agree to abide by the stated personal limitations and code of conduct.

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  • I, as the legal parent or guardian of the above mentioned participant, have made sure to inform my student/child of the expectations of participating on this trip.

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  • Release & Liability Waiver

  • I, the participant or for those under 18 the parent or legal guardian of the participant listed on this form, hereby consents to his or her full participation in the activities and trips of Southwoods Christian Church. I understand that accidents do happen, and hereby release Southwoods Christian Church and its ministers, directors, youth sponsors, leadership, adult leaders, student leaders, members, and other employees, volunteers, agents and representatives from any liability or other legal or financial responsibility for any negligence (including Southwoods Christian Church’s own negligence) or accidental injury to the above-named child while he or she is participating in the activities, services, gatherings, events, and trips of Southwoods Christian Church under the supervision of such person(s).
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