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Release (required for all participating minors and adult sponsors)
I,(Guardian), of city, State of Texas, hereby affirm that (I, or my child ) shall be participating in activities sponsored by White’s Chapel United Methodist Church, hereinafter referred to as “the activities”. I certify that I am cognizant of the inherent dangers associated with participating in the Activities and with the fact that participating in the Activities may take place outside of, or off, premises. I understand and agree that neither White’s Chapel UMC, nor its trustees, nor representatives, nor instructors, nor agents may be held liable in any way for any occurrence in connection with my or my child’s participation in the activities that may result in injury, harm, or other damages to my family or me. As a part of the consideration for being allowed to enroll and participate in the Activities, I hereby personally assume all risks in connection with participation in the Activities. I further release White’s Chapel UMC, its trustees, instructors, agents, and representatives for any injury or damage which may befall while enrolled or participating in the Activities. I further agree to save and hold harmless White’s Chapel UMC, its trustees, agents, and representatives from any claim by me, or my family, estate, heirs, or assigns arising out of enrollment and participation in the Activities. I further state that I am of lawful age and legally competent to sign the affirmation and release: that I understand the terms herein and contractual and not a mere recital: and that I have signed this document of my own free act and coalition. I further state and acknowledge that I have fully informed myself of the contents of this affirmation and release by reading it before I have signed it.
I,(Guardian), of city , State of Texas, hereby affirm that (I, or my child ) do hereby appoint the adult in charge of this event as his/her agent as my true and lawful, attorney in fact to act for me and in my name, place and stead; and to do any, every and all acts and exercise any, every and all powers that I might or could do in giving consent to emergency or non-emergency medical treatment for my minor child that he/she shall deem proper or advisable to do or exercise on my behalf. This appointment of the authorized adult sponsor as my attorney-in-fact for the limited purpose of consenting to emergency or non-emergency medical treatment for the above named minor child shall not terminate on my physical or mental disability subsequent to the date of execution hereof.
All medications brought on Student Events must be checked in with the Team Leader and listed on the above Release Form. It is recommended that only necessary prescription medications be brought on the trip as the medical volunteers will have over-the-counter medications available if needed. If you have questions concerning this matter, please discuss with a medical volunteer.
Sign below if you agree for the medical volunteer to dispense any needed over-the-counter medication per package directions. Examples of these medicines include:
If we do not have a parent or guardian’s signature, we will contact you prior to dispensing over-the-counter medications to your child.
I give permission for the medical volunteer to dispense over-the counter medication(s) to my child for self-administration at the medical volunteer’s discretion or dispensed by designated personnel as delegated by the medical volunteer. Additional comments may be written below signature.
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