Youth liability form

1. Explanation of Form: This form provides medical release in case of an emergency. It allows any medical care to be administered to those involved in youth activities at the East Grand Church of Christ. It applies to any and all activities in which an individual participates. An individual may not participate in any activity without having this form returned to the youth leader or church office.

    2. Assumption of Risk: I am aware that the East Grand Church of Christ youth activities could be hazardous. I am voluntarily participating in these activities and thereby agree to accept any and all risk of injury or death, and verify this statement by signing at the bottom.

    3. Release Form Liability: As consideration for being permitted by the East Grand Church of Christ or one of its affiliated organizations to participate in these activities and/or use their facilities, I hereby agree that I, my assignees, heirs, guardians, and legal representatives will not make a claim against, sue, or attach the property of the East Grand Church of Christ or any of its affiliates for injury or damage resulting from the negligence or other acts, howsoever caused, by any employee, agent, or contractor of the East Grand Church of Christ or its affiliates as a result of my participation in youth activities. I hereby release the East Grand Church of Christ and its affiliates from all actions, claims, or demands that I, my assignees, heirs, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in the youth activities of the East Grand Church of Christ.

    4. Knowing and Voluntary Execution: I have read this form and understand its contents. I am aware that this is a release of liability and a contract between me and the East Grand Church of Christ and its affiliates. I acknowledge that I am voluntarily participating in these activities and sign this agreement of my own free will.









I, the undersigned parent or guardian of the above-named child, a minor, do hereby authorize adult workers with the East Grand Church of Christ to consent to any examination, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care which is rendered under supervision of any physician, or surgeon 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. Further, as parent or guardian of the minor named above, I do hereby expressly consent that my son/daughter may receive emergency medical treatment from any physician, hospital, or other medical center without the necessity of first notifying me, and do further agree to hold blameless any physician, hospital or other medical center for rendering such services. I also acknowledge that a duplicate of this form is sufficient for medical consent as the original is kept on file at the East Grand Church of Christ, 2220 E. Grand, Springfield, Missouri.
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