MARANATHA STUDENT EVENT WAIVER

STUDENT INFORMATION

Student Name

First Name

Last Name

Date of Birth

YYYY

Grade

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent / Guardian Name

First Name

Last Name

Parent / Guardian Contact Number

(###)

###

####

GUARDIAN CONSENT / MEDICAL WAIVER / RELEASE

MFGF YOUTH/KID EVENT

I hereby affirm and agree that I am the parent or legal guardian of the above mentioned minor (“Minor”); that I am legally competent to sign this agreement and release; that I have fully informed myself of this agreement by reading it and signing; and that I have fully informed myself of the details and risks of the VENUE (stated above as event location) prior to signing this release. I grant permission for Minor to attend this EVENT (stated above as event). I agree, individually and on behalf of Minor, to release and to hold harmless Maranatha Full Gospel Fellowship, all affiliated churches and their agents, officers, directors, volunteers and employees (collectively referred to as “MFGF”) and the VENUE from liability of any kind, for Minor’s injury, death or damage to or loss of Minor’s personal property, resulting directly or indirectly from his/her participation in the EVENT or from MFGF’s negligence. I personally assume all risks and liabilities in connection with Minor’s participation in the activity and agree to indemnify MFGF and the VENUE from any liability assessed against MFGF or the VENUE as a direct or indirect result of Minor’s participation in the EVENT. This release includes all risks and liabilities connected with the EVENT, whether foreseen or unforeseen. In the event that Minor is injured during the EVENT, and I am unable to provide consent to his or her medical treatment, I authorize MFGF to consent on my behalf to the performance of any and all medical treatment, including anesthesia, judged necessary by MFGF, until I am able to provide consent or until someone legally able to speak on Minor’s behalf is made available. I understand that every effort will be made to contact me. I agree, individually and on behalf of Minor, to release, indemnify, and hold MFGF and the VENUE harmless from any liability which may be assessed against MFGF or the VENUE as a direct or indirect result of said medical treatment. I agree to pay or arrange for payment for all costs associated with said medical treatment.

Digital Signature of Parent / Guardian

By typing my full name below, I fully agree and consent to the above statement.

Health Insurance Carrier & Policy #:

Allergies:

Current Medications or Special Instructions:

Date of Last Tetanus Shot: