The undersigned does hereby give permission for my student(s) to attend and participate in the student ministry activities sponsored by the Student Ministry of Patterson Park Church in Beavercreek, Ohio. As a parent or guardian, I authorize any adult staff member of PPC, in whose care my student has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or hospital care. I understand every reasonable effort will be made to contact me prior to any emergency treatment of my student and that Student Ministry staff or their volunteers will not have the authority to withhold or withdraw life-sustaining procedures for my student. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned student pursuant to this authorization. Should it be necessary for my student to return home due to medical or disciplinary reasons, the undersigned shall assume all transportation costs and may even be required to provide transportation for the student in extreme circumstances. I agree to hold harmless, indemnify, and defend Patterson Park Church (including employees and representatives) from any and all liability for injury or damage, regardless of whether such injury or damage results from the negligence of Patterson Park Church or its employees or representatives. The undersigned does also hereby give permission for my student to ride in any vehicle designated by the Student Ministry staff at PPC while attending and participating in activities sponsored by PPC.
We (parent and student) understand that inappropriate behavior towards another student, adult leader, private party, church property, vehicles, the property or persons of places we may visit during an event, will result in the student being financially liable for their actions. In the event of property damage, the student and parent agree to reimburse all damages caused by the student.
By typing in the parent/guardian signature, I agree to the above PPC terms.
By checking the box, the student(s) agree to the above terms.
By typing in the parent/guardian signature, I agree that all of the above information is correct and accurate to the best of my knowledge.
