*By entering my name in the box above, I am providing my digital signature on this form.
I, the Parent/Guardian of the student listed on this form, certify that he/she has my full approval to participate in this Georgetown Christian Church Student Ministries program/event. The student identified on this form understands that all students are expected to abide by the program rules and be directly responsible to the GCC staff/sponsors directing this event. GCC Student Ministries assumes responsibility for discipline at the event and, if necessary, may, because of misconduct or disobedience, require a student to leave. In such an instance, I will assume full responsibility for returning the student home.
I understand that reasonable measures will be taken to ensure the safety and security of my child, however I do hereby agree to release and to hold blameless Georgetown Christian Church and its employees and sponsors from any claim resulting in an accident or loss by participating in any activities associated with GCC Student Ministries events/programs.
I consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of my child during any activity or event to be used, distributed, or shown by GCC for general publicity, or as the church sees fit.
Further, I do authorize the Minister or sponsors of this activity or any GCC sponsor or staff member, in the event that I cannot be reached by phone, to give consent to a physician and/or hospital for emergency medical or surgical treatment while on this trip. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment.
Further, I do certify that said child is covered by adequate accident insurance. My consent and signature is given above. I have read and agree to the information in this entire form.
