PARTICIPANT PERMISSION AND RELEASE OF LIABILITY
In order for my child to participate in activities sponsored by Central Church, Inc., I understand that I will be responsible for any medical expenses for myself and my dependents, if any, and to waive any legal right or claim against Central Church, Inc., its staff or Board of Directors that I might have as a result of injury incurred by participation in any such activity or travel to and from any such activity.
I understand and acknowledge that by signing this form I am authorizing any staff member, if in their sole discretion it is necessary, to administer first aid, contact a physician for medical treatment, summons emergency medical care, and/or to transport me/my dependent to a medical facility for treatment.
| ____________________________________________________ Participant (Please Print) |
_______________________________________ Date |
| ____________________________________________________ Parent or Guardian Signature |
____________________|___________________ Phone: Home Work or Cell |
| ____________________________________________________ Activity |