Word of Life Christian Center
Parent/Guardian Permission and Waiver of Liability Form
This form is unnecessary if the person is 18 or older
or if a parent and/or guardian is present and/or participating.
I give my son(s) / daughter(s) _________________________________________ permission to travel to _____________________________________________.
_____________________________________
Parent/Guardian Signature (legible signature)
Consent to Medical Treatment
Name of parent or legal guardian ______________________________________________________
Home Address ____________________________________________________________________
Street City State Zip
Telephone _______________________________________________________________________
Home Work Pager Cell
Please list any medical history information about your participating child that you feel would be important to know if medical care is required.
Allergies to medication? Which one(s)? _____________________________________
Medications currently taking _______________________________________________
Other necessary information _______________________________________________
I, the undersigned parent or legal guardian of the above named child, do hereby grant my permission for said child to receive emergency medical care if: (1) such care is deemed necessary by the adult supervisor having custody of my child at WOL Christian Center; (2) the proposed medical treatment or procedure are immediately or imminently necessary and any delay occasioned by an attempt to obtain my personal consent would reasonably jeopardize the life, health, or well being of the child affected; and (3) I cannot be personally contacted. I further acknowledge that I have read and understand the above statements.
_____________________________________
Parent/Guardian Signature (legible signature)
Waiver of Liability
In consideration of the possibility of injuries which could occur in this event, I hereby release all participating groups and persons officially connected with this event from any and all liability for any injury or damages whatsoever arising from any participation in this event.
___________________ ___/___/___ _______________________ ___/___/___
Witness (legible signature) Date Parent/Guardian Signature (legible signature) Date
If you are planning to attend, you must fill out this page of the permission form,
have it signed by your parent/guardian, and witnessed, and returned by_____________.
Thank you.