STUDENT MEDICAL, LIABILITY & MEDIA RELEASE
EVERY ACTIVITY SPONSORED BY GRACE CHURCH OF SEATTLE, WASHINGTON IS CAREFULLY PLANNED AND ADEQUATELY SUPERVISED BY MATURE ADULTS. HOWEVER, EVEN WITH THE BEST OF PLANNING AND PRECAUTION, UNFORSEEN EVENTS CAN OCCUR. BY SIGNING THIS FORM, I AGREE TO ASSUME AND ACCEPT ALL RISKS AND HAZARDS INHERENT IN CHURCH-RELATED SOCIAL ACTIVITIES. I ALSO AGREE NOT TO HOLD THIS CHURCH, ITS EMPLOYEES, ITS VOLUNTEER ASSISTANTS, OR CHURCH MEMBERS' PRIVATE FACILITIES, LIABLE FOR DAMAGES, LOSSES, OR INJURIES TO THE PERSON OR PROPERTY UNDERSIGNED. I ALSO HEREBY GRANT GRACE CHURCH PERMISSION TO USE PHOTOGRAPHS/VIDEO TAKEN OF MY CHILD FOR EDITORIAL, ADVERTISING, AND PROMOTIONAL PURPOSES FOR USE IN ANY PRINT OR ELECTRONIC MEDIA. I UNDERSTAND THAT I AM ELECTRONICALLY SIGNING BELOW FOR THE MINOR(S) LISTED ON THIS FORM AND THE SIGNATURE IS FOR MEDICAL, LIABILITY, AND MEDIA RELEASE PURPOSES. *
IN THE EVENT THAT I CAN NOT BE REACHED IN AN EMERGENCY DURING THE DATES SPECIFIED ON THIS FORM, I HEREBY GIVE MY PERMISSION TO THE PHYSICIAN OR DENTIST SELECTED BY THE CHURCH LEADERSHIP TO HOSPITALIZE, TO SECURE PROPER TREATMENT AND/OR INJECTION, ANESTHESIA, OR SURGERY FOR MY CHILD, AS DEEMED NESSARY.*