Participant/Parent Release Statement

I/we understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I/we cannot be reached in an emergency, I/we hereby give permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or order an injection, anesthesia, or surgery for the subject of this release as deemed necessary.
I/we understand all reasonable safety precautions will be taken at all times by Grace Pointe Assembly of God and its agents during the event/activity. I/we understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/we agree not to hold Grace Pointe Assembly of God, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this release.
Participant's Name
Participant's Name
Parent/Guardian Signature (if under 18 years of age)
Parent/Guardian Signature (if under 18 years of age)
Date
Date