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MEDICAL RELEASE AND INDEMNITY AGREEMENT
PARENTAL PERMISSION FORM
This form is valid for all Paramount Baptist Church Doxa events during the year June 2018 - May 2019.
We, the undersigned, DO HEREBY RELEASE, PROMISE TO SAVE HARMLESS AND PROMISE TO INDEMNIFY Brittanie Wooten, Paramount Baptist Church of Amarillo, Texas, and all adult sponsors of or for the Paramount Baptist Church (hereafter referred to as “INDEMNITIES” for and from any liability whatsoever for any injury, damage, accident, misfortune or death sustained by the undersigned minor during the aforementioned activities.
We the undersigned, further agree to hold the aforementioned INDEMNITIES harmless and to INDEMNIFY the same from any liability whatsoever resulting from any decision they, in their discretion, shall make, or any accident, injury, damage, death, or misfortune which might occur to the undersigned minor in connection with any activity, trip, event, or function involving or during the aforementioned activities sponsored by Paramount Baptist Church.
This agreement is given in consideration for the supervision and discipline to be provided on our behalf by said INDEMNITIES plus other good and valuable consideration.
Further, we hereby appoint Paramount Baptist Church of Amarillo, Texas and/or Brittanie Wooten and/or any adult staff to act in my (our) place in the place in the event said minor should require medical attention during classes, rehearsals, workshops, or outreach opportunities including travel. This appointment is for the purpose of securing benefits for the health and welfare of said minor and expressly includes the authority to sign releases to physicians who may render medical care and services. We promise to assume liability for payment for all such professional services, and to reimburse Paramount Baptist Church for any expense that may be incurred for treatment, care, drugs, and other services for said minor.
If the undersigned minor’s behavior is such that it endangers the welfare of others, Paramount Baptist Church or its adult sponsors have our permission to send said child home or to exercise such non-corporal discipline as they deem appropriate. If said child is sent home, I further agree to pay the transportation costs for the trip home.
This agreement shall be construed according to and governed by the laws of the State of Texas. All of the sentences, phrases and provisions of this agreement are distinct and severable, and if any clause, phrase or sentence shall be deemed illegal, void or unenforceable, it shall not affect the validity, legality or enforce ability of any other clause or portion of this agreement. It is expressly understood that any reference to “activities” contained herein includes all activities, functions, or periods of time for any duration when said minor is under the custody, control or direction of said “INDEMNITIES”.
WE HAVE READ THIS AGREEMENT IN ITS ENTIRETY.
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