Fall River Trip 2022

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Release of Liability and Medical Information

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I hereby consent to & authorize my child (above) to participate in “Fall River Trip 2022” conducted by Grace Community Church on Oct. 7-10, 2022. We further authorize my child (above) to travel with representatives of the Churches in private or churches vehicles. If a parent, family physician, or dentist cannot be contacted promptly, and a medical or dental emergency has been determined to exist, the undersigned parent or guardian of the child named above hereby authorizes any representatives of the Church for and on behalf of the undersigned, to consent to any x-ray, anesthetic, medical, surgical or dental diagnosis of treatment and any hospital care deemed advisable and rendered by any licensed physician, or surgeon, EMT, nurse, or dentist, whether in his/her office or in any licensed hospital or health care facility. This authorization is given in advance of any such required care for purposes of empowering any such representative or official of the Church to give the above described consent for any such medical, or dental, as he/she may deem advisable. We herby agree to pay any and all reasonable charges incurred as a result of any such medical or dental treatment and to hold the Church and its representatives and officials harmless. The undersigned hereby release the Church and its authorized representatives and officials of and from any and all liability to the undersigned arising out of or in connection with activities related to the Church, or any travel connected therewith, except for such liability as may arise from the gross negligence or willful misconduct on the part of the Church or its representatives or officials. To the extent that any applicable law prevents or prohibits the under signers’ release of the Church from any liability to child(above) as set forth herein, we hereby agree to indemnify and hold harmless the Church and its representatives and officials of and from any such liability as may be imposed upon any of them.

I have read and agree to the terms above

If my students becomes a discipline problem, I understand that I may be required to pick them up or arrange for their immediate transportation home at my expense. This will be determined by the youth leaders, and all monies for the trip are non-refundable. I have read and agree to the terms above

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Are there any medications or food allergies that we need to be aware of Yes No

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Fall River Trip 2022

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