PARENTAL PERMISSION/MEDICAL INFORMATION FOR Child’s PARTICIPATION IN Kid’s Unleashed Camp, March 23, 2024
Pillar Church
PO Box 586
San Luis Rey, CA 92068
Phone:760.505.0843
I hereby waive all claims, which I might have against Pillar Church, their agents and employees for injury, accident, illness, or death occurring during or by reason of the following PILLAR CHURCHʼS Kid’s Unleashed Camp.
(I) (We) (Parent) (Guardian) of the minor child named above do hereby authorize Pillar Church as agents for the undersigned to consent to any X-RAY examination, anesthetic, medical surgical diagnosis or treatment and hospital care which is deemed advisable by and is rendered under the general or specific supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, where such diagnosis or treatment is rendered at the office of said physician or at said hospital.
It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care required, but it is given in advance to provide authority and power on the part of the aforesaid agents to give a specific consent to any and all such diagnosis, treatment or hospital care which the aforesaid physician in the exercise of his best judgment may deem advisable. This authorization is given pursuant to the provision of Section 25.8 of the Civil Code of California.
In consideration of and the benefit to be derived by the undersigned here from, undersigned individually and or as a parent or guardian, for himself and/or themselves, his and/or their heirs, executors, administrators, and assigns hereby release and forever discharge Pillar Church, their officers, employees, servants, agents and all persons connected with the above mentioned of and from all rights, claims, demands, and actions that may now or hereafter have, for any loss, damage, or injury sustained by the undersigned before, during or after church-related events, activities, or trips.
Parent acknowledges that they have their own medical insurance and release Pillar Church from all medical liability.
#2 General Liability Release
Pillar Church is a nonprofit Christian corporation located in Oceanside, CA. Any minors who accompany Pillar Church on a ministry trip or other church-related trip do so only with full and expressed permission of minor’s legal parent/guardian. We are glad to act as a host organization while on a trip suggesting activities and assisting in transportation. We do, however, require that you sign the following agreement for each minor child accompanying Pillar Church on this trip.
In consideration of the services extended by Pillar Church, the parent/guardian of the minor volunteer / traveler fully and finally releases and discharges against Pillar Church, its representatives, agents, servants, employees or any of them, all actions, claims and demands whatsoever which the parent/guardian of the minor volunteer / traveler may have or which may here-after accrue in favor of any of the parent/guardian of the minor volunteer / traveler (including but not limited to all injuries to the person or property of the minor volunteer / traveler or the parent/guardian of the minor volunteer / traveler) however arising out of any matters, incidents, acts, equipment and /or circumstances, which them or any of them might otherwise now or hereafter have or sustain, upon any theory of liability whatsoever or howsoever claimed unless such liability arises as the result of the intentional or willful misconduct of Pillar Church or their employees or representatives, or any other persons or organization acting within the scope of their employment or relation to Pillar Church. The parent/guardian of the minor volunteer / traveler agrees to save and hold harmless and to fully and completely indemnify Pillar Church, its officers, employees and representatives against any and all claims, suits and/or judgments related to any of the matters as to which they or any of them are herein above released as well as against all claims, suits, damages, and/or judgments arising our of the acts or conduct of the volunteer / traveler and/or volunteer / traveler’s representatives, and against all loss, damage, liability, expense or costs by reason or on account of any such claim, suit or judgment. This release and indemnity agreement shall apply to all known, unknown and/or unanticipated injuries and damages resulting from or during the volunteer / traveler’s participation on the trip from any cause whatsoever, as aforesaid, and parent/guardian of the minor VOLUNTEER / TRAVELER INDIVIDUALLY AND ON BEHALF OF ALL OF HIS AFORESAID REPRESENTATIVES, HEIRS, DEVISEES, LEGATEES AND DEPENDENTS EXPRESSLY WAIVES THE PROVISIONS OF SECTION 1542 OF THE CIVIL CODE OF THE STATE OF CALIFORNIA AND ANY SIMILAR PROVISIONS OF THE LAWS OF ANY OTHER JURISDICTION, WHICH SAID CODE SECTION READS AS FOLLOWS:
“A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.”
#3 Parent/Guardian Permission and Responsibility
By signing the front of this document and being the legal parent/guardian of the aforesaid minor child, I expressly give my permission for aforesaid minor child to participate in the above listed event.
I understand that in the event that my child behaves in a manner deemed unacceptable by the adult leader, I will immediately pick up my child at my own expense or make arrangements for immediate pick-up my child at my own expense.
For the minor named in this registration, I give permission that any photos or video taken of my child or anything they write may be used for future printing and publication for promotional purposes, including but not limited to website photos and brochures used for advertising purposes .
HAVE PROVIDED ALL INFORMATION REQUESTED ABOVE TO THE BEST OF MY KNOWLEDGE AND ABILITY. ADDITIONALLY, I HAVE READ THE ABOVE RELEASE AND DISCLAIMER AND UNDERSTAND ITS PROVISIONS