Please fill out all fields below:
Medical Information
Terms of Agreement
- I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill.
- I understand that Choose Life Church and Shamwari4Jesus will not be held responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.
- I hereby give permission for my child to be photographed during the Choose Life PULSE YOUTH OUTREACH. I understand the photos will be used to keep journal of actvities, to share during power point presentation and for promotional purposes including flyers, brochures and on the internet.
- I understand that although my child's photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the propety of Choose Life Church.
- Choose Life Church, Shamwari4Jesus and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that children will be transported by bus to and from the location of Shamwari4Jesus and will not hold the bus company or driver responsible for any accident, loss or damage.
- Youth's photos and quotes may be used for publicity purposes.
- In case of an emergency, and if a family physician cannot be reache, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Response, and/or Physician).
