Liability & Medical Release Form

Fortville Christian Church

Lock-in

August 18th-19th, 2017

Liability & Medical Release Form

Child’s Name: ______

In an emergency, contact:

1. Name ______Phone ______Relationship ______

2. Name ______Phone ______Relationship ______

As the parent/legal guardian of the above described participant (under age 21), I authorize and assume full responsibility for any medical attention which may be necessary for my child, ______. I hereby forever release, acquit and discharge Fortville Christian Church and its sponsors, employees, agents, representatives, successors and assigns from any and all injuries, claims, demands, costs, loss of service, expenses, liabilities, compensation or damages sustained by my child whether arising now or after age of maturity, or sustains as parent(s) or guardian(s) of my child, on account of, or in any manner arising out of my child’s participation in the “outings” receipt of medication or medical attention; said release to be effective whether or not consequences arising from participation in the activities are know or anticipated. Such parent(s) or guardian(s) further agrees to indemnify, protect and save harmless the parties released herein from all claims, demands, liabilities, damages, judgments, costs, attorneys fees and expenses arising on account of any action, claim or demand by the minor, a parent, a guardian or any other person or entity arising from the child’s participation in the activities. I herby understand and acknowledge that it is my responsibility to obtain and understand the information regarding the event and I understand what my child will be participating in, and I herby give full consent for my child to participate, and I release the representatives of Fortville Christian Church, both of financial and legal obligations, during the period of Friday - Saturday, August 18th and 19th for any accidents that may occur. (This form permits Fortville Christian Church to seek immediate medical treatment for your child, however, this form does not require or obligate the members of the church to seek medical attention for your child. If your child is injured and taken to hospital for treatment, you will be contacted as soon as possible)

Parent/Guardian’s Signature: ______Date: ______

Additional Information Concerning Your Child:

" ………………………………………………………………………………………………

Information Regarding Trip or Outing

Please cut on the dotted line and refer to the back for outing information.

-  Drop Off -Friday August 18th at 6:30pm

-  Cost $5

-  Ages: K-5th*(K-1st must be picked up by 11pm or have an adult spend the night)

-  This is a “Reverse Lock-in”. Come wearing PJ to play outside in. Bring a set of “Daytime” clothes to change into for when we go to bed.

-  Items to bring: sleeping bag, pillow, toothbrush, toothpaste,

-  Please No Electronics, but do bring friends.

-  Permission Slips are available when you drop off or online at www.fortvillechristian.com/#/kids/lock-in.Bring sleeping bag, appropriate PJs, pillow, toothbrush, toothpaste, comb/brush

-  Pickup is Saturday starting at 8am. Please make sure to pickup on time so tired adults can get home J.