I, the undersigned, hereby give my permission for the child named on this registration form to attend this Vacation Bible School - Kids Camp sponsored by Simi Covenant Church. I agree tohold harmless Simi Covenant Church, its agents, employees, and volunteers and each of them, for any and all claims for injury, illness, cause of action, the rendering of emergency care, or liability related to use of or participation in any Simi Covenant Church activities. I understand that these activities will include Christian spiritual training.
In the event that I cannot be reached or am unavailable in an emergency and my child requires treatment, I hereby authorize the Pastor / Supervisor and his/her officers, agents, servants, volunteers, or employees who are 18 years of age or older, who supervise the activities at this church into whose care my child has been entrusted, to consent to medical care or dental care, or both, for my child. The authority granted by this authorization includes the authority to consent to any x-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act for my child. This authority also extends to any x-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care by a dentist licensed under the Dental Practice Act for my child. I further authorize the Pastor / Supervisor and his/her officers, agents, servants, volunteers, or employees who are 18 years of age or older, who supervise the activities at the church to receive physical custody of my child upon completion of any treatment, and I specifically instruct any treating health facility to surrender physical custody of my child to the Pastor / Supervisor and his/her officers, agents, servants, volunteers, or employees who are 18 years of age or older who supervise the activities at this church. It is understood that this authorization is given in advance of any special diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of the supervisor and his/her authorized designee, in the exercise his/her best judgment on what is advisable for my child’s care, upon advice of such physician, dentist, and surgeon. I also give permission for transportation to emergency locations by authorized vehicles.
Any cost incurred not covered my insurance will be paid by me. I agree to waive and release Simi Covenant Church, its officers, agents, employees, and volunteers from and against any and all claims, cost, liabilities, expenses or judgments, and hereby agree to indemnify and hold harmless Simi Covenant Church from and against any and all such claims.
I also give Simi Covenant Church permission to photograph and videotape my child for future promotional materials, including Simi Covenant Church website posting, without expectation of compensation.