FAMILY MINISTRIES MEDICAL AND LIABILITY RELEASE

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REQUIRED FOR ALL STUDENTS AND ADULTS ATTENDING A JOURNEY OF FAITH EVENT 

If you or your child requires medical attention for pre-existing injuries or illnesses, please provide the necessary information to give you or your child the prescribed medical attention during an activity or trip. In the case of illness or injury, while you or your child is at an activity or trip, your medical insurance will be billed for medical charges. Any updates to your insurance policy must be provided to Student Ministries. 

Authorization of Consent to Treatment of Self or Minor: (I) (We) , the undersigned, parents (s) of (self or a minor) , do hereby authorize Journey of Faith Church youth ministry leaders as agent (s) for the undersigned to consent to any dental care,    x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is  deemed advisable by, and is rendered under the general or specific supervision of, any physician and surgeon licensed under the provision of the Medical Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or at a hospital. 

It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of our aforesaid agent (s) to give specific consent to any and all such diagnosis treatment or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable. This form is for any and all events, projects, ministries, small groups, or trips involving Journey of Faith Church . It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required. The above authorization is given pursuant to the provisions of Section 25.8 and 34.6 of the Civil Code of California and shall remain effective through the above-named minor’s graduation from high school, unless sooner revoked in writing delivered to said agent (s).

Release of Journey of Faith:  (self/parent’s) shall indemnify, hold free and harmless, assume liability for, and defend Journey of Faith Church , its agents, servants, employees, officers, and directors from any and all costs and expenses including but not limited to, medical costs, attorney’s fees, reasonable investigative and discovery costs, court costs, and all other sums which Journey of Faith Church , assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of (self/child’s) use of real or personal property belonging to Journey of Faith Church , as agents, servants, employees, officers, and directors, or by action or omission by (self/child’s) .

Also, Journey of Faith Church reserves the right to use any audio, video, and/or photography of guests and/or campers participating in Journey of Faith Church facilitated events. 

IT IS ALSO ACKNOWLEDGED THAT IF YOU OR YOUR CHILD HAS TO RETURN HOME EARLY FOR DISCIPLINE VIOLATIONS, IT WILL BE AT YOUR OR THE PARENT/GUARDIAN’S EXPENSE. 

By signing this document, I acknowledge that I have had sufficient opportunity to read this entire document. I have read and understood it, and agree to be bound by its terms. 

1243 Artesia Blvd., Manhattan Beach, CA 90266 | 2200 W. Carson St., Torrance 90501

310-372-4641

 


Parent Information

In an Emergency, if parent/guardian cannot be reached, please notify:

Insurance

Doctor

You will receive information and updates on Hume Lake and other Family Ministry events

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.