PERMISSION SLIP

LIABILITY RELEASE FORM

Please fill out the following form.

Heirborn Lock-In 2/13-14/26

I give my child permission to attend the HEIRBORN LOCK-IN  Feb. 13^th 7 PM - Feb 14^th 7 AM at JUBILEE WORSHIP CENTER

 I understand that there is no cost for this event. By signing this permission slip, I agree that if my child does not follow the guidelines set by his/her chaperone, that he/she will not be allowed to participate in the next two (2) events sponsored.

We (I), being 21 years of age or older, do for ourselves (myself) and for and on behalf of my child(ren) participant if said child(ren) is not 21 year of age or older, do hereby release, forever discharge and agree to hold harmless Jubilee Worship Center/Jubilee Child Care Ministry.  And the director 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 activity. 

Furthermore, we (I) [and on behalf of our (my) child(ren) participant, if under the ages of 21 years] 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 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 a result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.

(If the participant has not attained the age of 21 years)

We (I) are the parents or legal guardians of the participant and hereby grant our (my) permission for him/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.

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action, or otherwise, we (I) hereby assume all transportation costs.

(Only participant need sign if 21 years of age or older.  Otherwise, both parents must sign unless parents are separated or divorced in which case the custodial parent must sign.)