The undersigned(s) being the lawful parent(s) and/or guardian(s) of the above student hereby consent(s) to the participation by the student in the Anchored Youth Fall Retreat dated 10/13/2017-10/15/2017, conducted by the Calvary Chapel Of Clayton Youth Group at Quaker Lake Camp & Conference Center; 1503 NC Hwy 62 E, Climax, NC (www.quakerlakecamp.org)
I, the undersigned parent or legal guardian of the student named above, do hereby grant my permission and consent for the said student to attend and participate in the events and activities of Calvary Chapel Of Clayton's Youth Ministry, both on and off church grounds, including the necessary transportation to and from these events and activities.
Permission is granted for my student to receive medical care if; (1) such care is deemed necessary by the person in charge of the event; (2) the proposed medical treatment or procedures are immediately or imminently necessary and any delay occasioned by an attempt to obtain my parental consent would reasonably jeopardize the life, health or well-being of the student affected; (3) I cannot be personally contacted.
I further authorize(s) any of the staff, employees, agents and representatives of Calvary Chapel Of Clayton to provide for, approve and authorize any health care at any hospital, emergency room, doctor's office or other institution; employ any physicians, dentists, nurses or other person whose services may be needed for such healthcare; review and if necessary disclose the contents of any medical records; execute any consent form required by medical, dental or other health authorities incident to the provision of medical, surgical or dental care to the student. Healthcare shall include but not be limited to the administration of anesthesia, X-ray, examination and performance of operations, diagnostic and other procedures.
If there is no medical emergency, Calvary Chapel Of Clayton's staff or representative will first use reasonable efforts to contact the parent(s) and/or guardian(s) before administering or authorizing any treatment.
Notwithstanding other provisions in this Consent Form, Calvary Chapel Of Clayton shall not have the authority to withhold or withdraw life-sustaining procedures for the student.
I further agree not to hold Calvary Chapel Of Clayton or any of its paid staff or volunteers responsible for any incident that may occur on the way to, from or during an event. I indemnify, defend and hold harmless Calvary Chapel Of Clayton for all claims made and liabilities assessed against them as a result of any event or activity. I release Calvary Chapel Of Clayton and all medical providers from liability in acting on my behalf in this regard and rendering such medical treatment. I assume the risk and financial responsibility for any injury resulting from any event or activity.
Furthermore, I understand and assume the expenses of any property damage caused by my student. Should it be necessary that my student be returned home due to disciplinary action (when on trips), I will be contacted by the leaders and will be responsible to pick my student up and assume the cost of transportation.
By filling in my name below, I am acknowledging that I have read through and understand the above statements.
*Please note parent/guardian, we will confirm that you have read and agree with the statements above at Check-In.
**In an emergency we will attempt to make contact with Parent/Guardian first. In the event we are unable to get a hold of the Parent/Guardian we will attempt to contact emergency contacts listed.
If YES, please put all medications in a ziplock baggie labeled with your student's name, include inside the baggie, the name of each medication and specific instructions to administer so that our Medical Steward can administer them properly and timely.
Parents/Guardians, please note, ALL medications must be checked in with Medical Steward on Departure Day.
IMPORTANT INFORMATION: Parent(s)/Guardian(s) MUST accompany their student(s) at Check-in on Departure Day.
Your Student will not be able to attend the event or activity if you drop them off and leave before going through our Check-in Process.