Release of Liability, Photo/Video Release,
and Consent to Medical Treatment
Parental Consent. The undersigned does hereby give permission for our (my) child, to attend and participate in Vacation Bible School ("VBS") outings sponsored by Fellowship Reformed Church ("FRC") for June 19 - 22, 2017. I request permission for my child to participate in the various on and off site activities of the VBS program. In consideration for the agreement by FRC to permit my child’s participation, I, for myself, my minor child(ren) and for my child(ren)’s other parent and/or guardian, hereby release, waive, discharge, and covenant not to sue Fellowship Reformed Church of Hudsonville, and its officers, directors, employees, agents, volunteers, heirs and assigns (together "FRC") of and from all liability, loss, claims, demands, possible causes of action, court costs, attorneys' fees and other expenses arising from any claim or lawsuit of any kind that may otherwise accrue from any loss, damage or injury to my child(ren)’s person or property in any way resulting from or connected with my child(ren)’s participation in any ministry activity at FRC, including, without limitation, the failure of anyone to enforce rules and/or regulations, failure to make inspections, or the negligence of other persons. If any claim or lawsuit is brought, this release shall be enforced under Michigan law. Any claim or lawsuit must be brought within 180 days from the date of the alleged loss, damage or injury.
We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my) child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs. The undersigned does also hereby give permission for our (my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by FRC. This Authorization shall be effective for 1 year from signed date unless earlier revoked in writing.
Photo Release. I give permission for my child(ren)’s photo, which may be taken during any ministry activity, to be used for publication purposes and/or to appear on the church website, www.frchudsonville.org.