Grace Bible Church- Consent & Release Form

This form must be returned by__________, 2007

     I, _______________________(Parent), hereby consent to my child,_______________________, participating in

 _______________________________________, an event sponsored by Grace Bible Church of Hudson Flordia (hereafter, "the Church") on ______________________ (Date of Event). I certify that my child is able to participate in these activites. If my cild has medical conditions, which may be relevant to a physician in the event of an emergency, I have listed them below. In the event an emergency occurs, I may be reached at the telephone number listed below. If I cannot be reached, I hereby authorize THE ATTENDING PHYSICIAN  to make emergency medical decisions for my child. If there are any activities I do not want my child involved in, I have listed them below.  

I understand and hereby agree to assume all of the risks, which may be encountered on said activity, including transportation to and from the event and activies preliminary and subsequent thereto. I do hereby agree to hold the Church and it's officers, agents, and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or proberty, even injury resulting in death, whisch I now have or which may arise in the future in connection with the activity or participation in any other associated activities.  I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the state of Florida and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between parties thereto, and the terms of the release are contractual and not a mere recital.  I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement, which I have read and understood.

Medical Conditions to be aware of:

___________________________________________________________

Physical restrictions:

___________________________________________________________

I do not want my child to participate in the following:

___________________________________________________________

__________________________  ___________  (______)____________

Parent/Guardian Signature                Date         Emergency Phone Number