Emergency Authorization: I, the undersigned, parent or legal guardian of the participant, a minor, hereby authorize the coaches, assistant coaches or volunteers acting in the capacity of activity supervisors, as my agents to consent to medical, surgical or dental examination and/or treatment. In case of emergency, I hereby authorize treatment and/or care at any hospital. If there is an emergency and I cannot be reached, please contact the following emergency contact:
Does this child have any disabilities, handicaps, present injuries or limitations, allergies, hemophilia, heart condition, history of respiratory illness or other significant medical condition? If yes, please describe
In the unlikely event of a medical emergency, would you like your family physician to be contacted? If so, please list the doctor's name and contact information.
WAIVER OF LIABILITY, DISCLAIMER AND PERMISSION: I, the parent or guardian of the above named individual, acknowledge that participation in athletic events necessarily involves the risk of physical injury. I further acknowledge that the programs of Calvary Baptist Church are primarily administered by volunteers rather than trained professionals. In consideration for accepting the registration of the above named individual and permitting the voluntary participation of said individual in its programs, I (for myself as well as for my child, his heirs and assigns) hereby release, discharge and hold harmless Calvary Baptist Church, its employees, volunteers and other representatives or affiliates from and against any claims arising out of or relating to illness, physical injury, death or other damages that may result to said individual while participating in a Calvary Baptist Church sponsored event, including any injury by the negligence of any official, referee or coach while performing his/her duties during any activities. I attest that my child is physically capable to participate in this event. However, should officials, representatives or volunteers determine in their sole discretion that completion or participation in any activities would be injurious to my child’s health, or should my child become ill or injured, I consent to his or her removal and treatment by any physician or medical care provider at the direction of the event officials or sponsors, representatives or volunteers. Please sign your name below.