ASSUMPTION OF RISK AND RELEASE OF LIABILITY AGREEMENT AUTHORIZATION FOR MEDICAL TREATMENT OF A MINOR AGREEMENT MEDICATION AUTHORIZATION AND RELEASE AGREEMENT
WHEREAS, THE UNDERSIGNED (the applicant) wishes to be accepted for participation in all activities conducted by GOD IS GOOD MINISTRIES OF DALLAS, INC.
In consideration of, and for the right to participate in such activity by GOD IS GOOD MINISTRIES OF DALLAS, INC., it’s Directors, Officers, Trustees, Employees, Agents, and/or Associate, I/we have and do hereby assume all of the risks and any other ordinary risk incidental to the nature of the activity. Further I/we will hold them harmless from any and all liability, actions, causes of action, debts, claims, and demands of every kind and nature whatsoever, whether for bodily injury, property damage or loss, medical bills, hospital bills, and doctor bills, or otherwise, which the participant now has or which may arise from or in connection with participation in any other activities arranged for me by GOD IS GOOD MINISTRIES OF DALLAS, INC. it’s Directors, Officers, Trustees, Employees, Agents, and/or Associates, and their heirs, executors, and administrators, successors and assigns and for all members of my family, including any minors accompanying me. I/we fully understand that my physical activity involves risk of injury. I/we also understand that my participation in any activity is entirely VOLUNTARY. I/we enter into this activity and take full responsibility for the decision to participate or not to participate and agree to follow all safety instructions.
I do hereby release GOD IS GOOD MINISTRIES OF DALLAS, INC., it’s Directors, Officers, Trustees, Employees, Agents, and/or Associate any liability whatsoever (including acts of negligence) arising out of an injury, damage, death, or loss, whether physical, mental or emotional, which may be sustained to the Child/Participant, during the course of his/her involvement with this camp or any overnight camping before the camp session. I consent to the use and display of photographs (possibly on the internet) which include my child(ren) taken during the course of this camp.
I consent for emergency medical treatment to be administered to the applicant by a licensed physician, adult staff member or other emergency medical personnel chosen by the Camp Director or another camp official. I give permission for the camp director or another camp official to administer “over-the-counter” medications and/or prescription medications (listed above, or prescribed during camp) to the child listed above if necessary. I assume all financial responsibility for medical expenses incurred on behalf of the child listed above resulting from any accident or emergency during activities related to Jesus Camp.
I/we hereby authorize the camp nurse or camp director to administer the medication listed on this form. If a medical emergency should arise while the applicant is in attendance at GOD IS GOOD MINISTRIES, I/we hereby authorize the camp nurse or designated adult to provide care and/or transport to a medical facility. I/we further authorize the health care provider of the medical facility to administer necessary medical and /or surgical care upon arrival at the medical facility. I/we understand that camp officials will make a conscientious effort to locate the emergency contact listed on this document before any action will be taken. If it is not possible to locate the emergency contact listed, I/we will accept the expense of emergency medical and/or surgical treatment.
I/we give my authority and consent for GOD IS GOOD MINISTRIES OF DALLAS, to treat my child for a headache, fever, or upset stomach with the appropriate non-prescription medication including Aspirin and Pepto-Bismol. I hereby agree that all health history is correct and complete as far as I know and the person herein described has permission to engage in all camp activities except as noted.
I understand that if my child refuses to follow camp rules, a parent/guardian must pick the child up at the campgrounds immediately. It is approximately a 2 hour drive from Dallas to campgrounds.
I hereby agree to the "ASSUMPTION OF RISK AND RELEASE OF LIABILITY AGREEMENT, AUTHORIZATION FOR MEDICAL TREATMENT OF A MINOR AGREEMENT, MEDICATION AUTHORIZATION AND RELEASE AGREEMENT" including all statements listed on this form.