Describe in detail the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation, handicap, disability, or condition to which your child is subject and of which the staff should be aware, and what, if any action of protection is required on account thereof. Include names of medications and dosages that must be taken.
I recognize that there are risks involved in participating in these activities and hereby assume all risk of injury, harm, damage, or death in connection with my participation in this activity. I understand and agree that neither Westlake Church nor its trustees, officers, directors, employees, agents or representatives may be held liable in any way for any injury, harm, damage, or death that may occur to me as a result of my participation in this activity and hereby release Westlake Church, its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death, which may occur while I am participating in this activity. To the fullest extent permitted by the law, I agree to save and hold harmless Westlake Church, its trustees, officers, directors, employees, agents and representatives from any claim by myself, my estate, heirs, successors, assigns or other persons arising out of my participation in the activity.
I authorize Westlake Church through its trustees, officers, directors, employees, agents or representatives to render or obtain such emergency medical care or treatment for me as may be necessary should any injury, harm or accident occur to me while participating in this activity.
I understand and acknowledge that Westlake Church does not provide health or medical insurance in connection with the activity and I agree that I will be financially responsible for any bills incurred as a result of medical treatment, including emergency medical treatment and/or transportation to a medical facility, in connection with my participation in the activity.
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