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Liability Release Form

Release of All Claims

In consideration for being accepted by The South Carolina Church of Y&D Department for participation in the _________________________________ we (I), being 21 years of age or older, do on behalf of my child-participant hereby release, forever discharge and agree to hold harmless South Carolina Church of God and the directors thereof from any and all liability, claims or demands for personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above described trip or activity.

Furthermore, we (I) on behalf of my child-participant hereby assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein.

Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food, and lodging for this participant.

 The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees, and agents, for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto. 

We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for her to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any. 

List any medical conditions, medications and/or allergies

__________________________________________________________________________________________________

_______________________________                                           _____________________________________________________

(Type or print name of participant)                                                                          Father                                                    Date

__________________________________________________                     ____________________________________________________

 [Parent(s) telephone]                                                                                               Mother                                                      Date

_______________________________________________________          

                                                                                                                        ___________________________________________

 (Pastor’s telephone)                                                                                                 Legal Guardian                                         Date

Insurance Company______________________________              

Policy #__________________________________________           

Physician_________________________________________          

Physician’s Phone________________________________

Emergency Phone Numbers_______________________________________________________________                                             

Dear Parent/Guardian,

     The ________________________________________ will be

going on a trip to

______________________________________________ .  We will be

leaving the church at ____________ .  Our goal is to be back

by ____________________.   

     The boys will need to bring 1) sleeping bag 2) change of

clothes (preferably old clothes) 3) Spending money (for 2

meals & camp store). 

     If you would like your son to attend please 1) let

___________________ know 2) fill out the permission slip and

liability form.

     During the time of the trip if you have any questions

please call _________________________________.

Permission Slip

I, ____________________________, have read all the above and give

    (Parent/guardian name)

permission

for my  son, _______________________, to attend the weekend camping

trip. 

    I understand that the leaders of the ______________________ will do

their best to protect my child but will not hold the leaders

nor the ____________________________ Church of God responsible

for accidents.

                                               _______________________________

                                                    (Parent/guardian signature)

If you know of any medical conditions or allergies that we need to know about please list below.

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________