Authorization to pick-up (besides parents)
Publicity Release Agreement
I hereby consent to the use of my child(ern)s name, photograph, video or other likeness by Calvary Missionary Baptist Church in all marketing and advertising materials, publications, word of mouth programs, social networking sites, websites and/or in media interviews without restriction as to form, maner, frequency or duration of usage. I further agree that my name and/or photograph and/or video and/or other likeness may be used with whatever visuals, copy or other elements in Calvary Missionary Baptist Church's online newsletters, social networking sites, websites or visual, electronic or print media, and I agree that all such materials produced hereunder are and will remain the sole and exclusive property of Calvary Missionary Baptist Church and will not have to be reviewed with or by me prior to their use.
Medication Administration Authorization Form
This form is only valid for the 2019 summer summer activities at Calvary Missionary Baptist Church.
This form must be completed before the medication can be administrated here at Calvary Missionary Baptist Church.
Perscription must be in a contatiner labled by the pharmacist or provider
Non-prescription medication must be in original container with label intact
An adult must bring the medication to the Club
I request the church personnel to administer the medication as prescribed above. I certify that I have legal authority to consent to medical treatment for the child named above including the administration of medication. I understand that the medication must be picked up by an adult.
Informed Consent and Acknowledgement
I hereby give my approval for my child’s participation in any and all activities prepared by Calvary Missionary Baptist Church. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Calvary Missionary Baptist Church and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected sessions. In case of injury to said child, I hereby waive all claims against Calvary Missionary Baptist Church, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all recreational activities, including field games. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization
As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.
Permission is also granted to the . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.
Release authorized on the dates and/or duration of the registered season.
This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.