Huntington Beach Community Church
Rock-N-Water
July 6-10
Having custodial care for ______________________________________, I give my permission for him/her to attend this event.
I hereby agree that I, my heirs, distributees, guardians, legal representatives, and assigns, will not make a claim against, sue, attach the property of, or prosecute the Huntington Beach Community Church and/or its employees, officers, officials, volunteers, boards, departments, agents, and contractors for emotional distress, bodily injury or death to _______________________________________, or property damage arising out of any actions by any employees, officers; officials, volunteers, boards, departments, agents, and contractors in connection with my student’s participation in this activity.
In addition, I hereby release and discharge the Huntington Beach Community Church and its employees, officers, officials, volunteers, boards, departments, agents, and contractors from all actions, claims, or demands I, my heirs, distributees, guardians, legal representatives or assigns now have or may hereafter have for emotional distress, bodily injury or death to my minor child, or property damage resulting from his/ her participation in this activity.
In case of accident or other emergency, personnel of the Huntington Beach Community Church and/or its‑agents, are hereby authorized to secure medical care deemed necessary as a result of accident or injury, for the participant. I further agree to pay any and all costs incurred as a result of treatment.
I further permit the use of activity/event photography and/or video taping for promotional use.
Lastly I authorize temporary custodial care of my minor child to Dr. Michael J. Boswith for the duration of the event. If it becomes necessary for my child to be sent home I agree to pay all the necessary expenses to insure his/her safe return.
________________________________________ ____________________________
Signature date
________________________________________ ____________________________
Print Name phone
________________________________________________________
Address
_______________________________________ ____________________________
City/State/Zip email