Release of Liability
1. I, the lawful parent or guardian, of the above named child(ren), give permission for my child to participate in the International Church of the Foursquare Gospel’s (I.C.F.G.) event in which he/she is registering/participating. I also agree to hold harmless from all liability and indemnify the International Church of the Foursquare Gospel; NewHeart Foursquare Church, and its directors, officers, council, agents, representatives, volunteers, and employees (“church”) from any and all liability, claims, judgments, cost or expense, including attorney fees, arising out of any damage, injury or illness incurred or caused by my child while participating in or traveling to or from the activity, or otherwise in church custody.
I understand the risks in these activities, including the possibility of unforeseen hazards, serious injury or death. I certify my child is able to participate in the activity.
2. I agree to instruct my child to cooperate with the church and it’s representatives in charge of the activity and understand my child may be prohibited from participating and/or sent home for any failure to follow the rules established by the church and/or facility in which they are attending.
3. I appoint church representatives who are acting as leaders, or designated by such leaders as my attorney in fact to act for me in my name and my behalf, in any way that I could act if I were personally present with respect to the following matters if any injury, illness or medical emergency occurs during the activity, related travel or while my child is in church custody.
A. To give any and all consents and authorization to any physician, dentist, hospital or other persons or institutions pertaining to any emergency actions as our medical attorney in fact shall deem necessary or appropriate for the best interest of the child, including but not limited to: diagnostic, treatment, operative procedures and/or x-ray treatment.
B. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above named student.
C. I understand the church will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my child.
D. I have not been given guarantee as to the results of examination or treatment. I have included medical insurance information in which to pay for necessary care.
4. I understand that the church’s insurance is secondary to my own primary coverage, which I am responsible.
5. I agree that the church may use my child’s and or my own, voice, portrait, photograph or image for promotional website, office or any other church related purpose. These may be used in any broadcast, telecast, digital or print medium, including video images, photographs, pictures or renderings, audio recordings, or other likenesses, in combination or alone. Any specific restrictions on use or broadcast can be requested in writing to church.
