Please sign by typing your full name in the box below.
Liability Release
In consideration of Crossroads Presbyterian Church allowing the Participant to participate in disAbility Ministry activities and programs, children/youth ministry (Sunday worship, Sunday meeting, Activities, Events, Retreats, Trips) and childcare, I, the undersigned, do hereby release, forever discharge and agree to hold harmless Crossroads Presbyterian Church, its pastors, directors, employees, volunteers, and teachers (collectively herein the "Church") from any and all liability, claims, or demands for accidental personal injury, sickness, or death, as well as property damage and expenses, of any nature that may be incurred by the undersigned and the Participant while involved in the church/youth activities and childcare. I the parent, or legal guardian, of this Participant hereby grant my permission for the Participant to participate fully in children/youth activities and childcare, including trips away from the church premises. Furthermore, I on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify said Church for any liability sustained by said Church as a result of the negligent, willful, or intentional acts of said Participant, including expenses incurred attendant thereto.
Medical Treatment Permission:
I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical, or dental diagnosis, or treatment 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 provision of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned 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 or youth pursuant to this authorization.
Early Return Home Policy
Should it be necessary for my child or youth to return home due to medical reasons disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility.
