By signing this form, I, the undersigned, do give my permission for the WIRED WEEKEND Staff, medical staff, adult present or in charge of first aid, or church official responsible for transporting my child to and from the event to provide medical treatment in the case of sickness or injury to my child, while on the event location or in route to and from said location.
If the staff at WIRED WEEKEND see that my child needs medical attention that the facility health professional cannot give, the emergency contact listed above will be notified and my child will be taken to a nearby hospital. WIRED WEEKEND is not responsible for any injury my child may experience while he/she is on the grounds.
I, the undersigned, will be responsible for all medical treatment and/or medications that may be necessary, beginning the first day of the event and continuing until the last day of the event. Jesus Name Church (Plainview), WIRED WEEKEND or any of its officials or staff will not pay for or be responsible to pay for any medical treatments or medications. All responsibility will lie with the parent, legal guardian, or adult that signs this document. I acknowledge that I have completely understood this release statement and all its terms and by checking the box below, I consent to the use of this e-signature and understand that by e-signing I am legally bound to the terms of this document.