Parental Consent and Liability Form

On behalf of our child, we do hereby release, forever discharge and agree to hold harmless, the Fluvanna Community Church and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses of any nature whatsoever which may be in current by child-participant while participating in church-sponsored activities. On behalf of our child we hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. Further, authorization and permission is hereby given to said church to furnish any necessary transportation and food for this participant in any way as necessary.

We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him or here to participate fully in Fluvanna Community Church-sponsored activities.

We (I) understand that every possible action will be taken to locate us (me) to make medical decisions in an emergency, however we (I) also give permission to take said participant to a doctor or hospital for emergency surgery or medical treatment in our (my) absence, and responsibility of all medical bills, if any.