Age as of July 9, 2018
We/I, the undersigned, do hereby agree to, and/or give permission for our/my above listed children to, attend and participate in any and all activities for the Vacation Bible School (VBS), sponsored by Chinese Baptist Church on July 9-13, 2018 (hereinafter referred as the ”EVENT”). During participation in the EVENT, We/I, either for ourselves, and/or on behalf of our/my minor children, fully agree, approve, authorize and consent, and without any reservations, to have an adult, in whose care the minors (and/or We/I) have been entrusted, to any X-ray examination, anesthetic, medical, surgical, vision or dental diagnosis or treatment, emergency care and hospital care, to be rendered under the general or special supervision and on the advice of any physician, dentist, vision care personnel on the medical staff of a health care facility, whether such diagnosis or treatment is rendered at the office of said physician, out-patient center or at a hospital. The undersigned shall be liable and agree to pay any and all costs incurred in connection with such medical, vision, dental, and/or emergency care services rendered to the above referenced adult or minor person(s) pursuant to this authorization. Should it be necessary for our/my children (and/or for us/me) to return home due to medical or any other reasons, We/I shall assume, and without any reservations, all transportation and related costs. The undersigned also authorize and give permission for our/my children to ride in any vehicle designated by the adult(s) in whose care the minor has been entrusted while attending and participating in activities sponsored by Chinese Baptist Church. By registering, We/I fully consent, and/or for any and all of my family members, to be photographed, audio, and/or videotaped, as the EVENT is documented, and fully consent to the possible and reasonable use of those photos, audio and/or videotapes by Chinese Baptist Church. The undersigned, either ourselves and/or on behalf of our minor children, further agree to defend, indemnify and hold harmless Chinese Baptist Church, its pastors, staff, deacons, committee members, organizers, volunteers or church members from any and all liability, loss, requests, demands, bodily injury, property damage, claims, cross claims, third-party claims, complaints, direct actions, wrongful death claims, administrative proceedings, legal or non-legal actions, medical liens, claims of subrogation, or for contribution, and expenses arising out of or in any way related to me, my family, our/my minor children and/or other related family members in our participation in the EVENT.In case of any dispute, We/I agree to resolve this peacefully and will select mediation as an alternative dispute resolution, the expenses of which will be shared by us/me and the Chinese Baptist Church equally, if any.
Enter your name in the above box if you acknowledge this agreement.