I hereby acknowledge that it is my desire for my child to participate in church-sponsored activities at the

First Baptist Church of Plainfield including activities on and/or away from the church premises as well as

transportation to and from these activities.

 

I understand that in the event medical intervention is needed, every attempt will be made to contact

immediately the persons listed on this form. In the event, I cannot be reached, I hereby give my

permission to the physician, nurse or dentist selected by the First Baptist Church of Plainfield to secure

medical and dental aid as required for illness or injury under a physician's orders, including transportation

to and from the necessary facilities.

 

I understand all reasonable safety precautions will be taken at all times by the First Baptist Church and its

agents during the events and activities. I understand the possibility of unforeseen hazards and know the

inherent possibility of risk. I agree not to hold First Baptist Church, or any officer, employee or agent of

First Baptist Church of Plainfield liable for damages, losses, diseases, or injuries incurred by the subject of

this form.

 

I verify under the penalties of perjury that all the information given is true and correct as far as I know. I

have carefully read this agreement and fully understand its contents. I am aware that this is a release of

liability and an assumption of risks and sign it of my own free will.

 

This form shall remain effective through October 31, 2010 or until revoked in writing and delivered to any

officer, employee or agent of the First Baptist Church of Plainfield.

Parent/Guardian Signature ____________________________________Date______________