BY FILLING OUT AND SUBMITTING THIS FORM, PARENT/GUARDIAN IS GIVING PERMISSION FOR PARTICIPANT TO ATTEND THIS EVENT WITH MONTAVILLA CHURCH.

PARENT/GUARDIAN AGREES THAT MONTAVILLA AND/OR ITS LEADERS ARE NOT LIABLE FOR ANY ACCIDENT OR INCIDENT RELATED TO EITHER THE PLANNED EVENT OR TRANSPORTATION TO OR FROM THE EVENT. NOR ARE THEY LIABLE FOR ANY INJURIES SUSTAINED, OR ANY LOST, STOLEN OR DAMAGED ARTICLES. I AUTHORIZE MONTAVILLA CHURCH AND/OR ANY ADULT LEADER TO OBTAIN THE SERVICES OF A PHYSICIAN AND/OR HOSPITAL FOR THE CARE OF MY CHILD, IF NECESSARY, INCLUDING EMERGENCY MEDICAL CARE, EMERGENCY X-RAYS, AND/OR EMERGENCY SURGERY. SHOULD THE NEED ARISE, I ALSO AUTHORIZE MONTAVILLA CHURCH AND ITS LEADERS TO INCUR ANY NECESSARY EXPENSES FOR SUCH SERVICES IN THE EVENT OF ACCIDENT OF ILLNESS, AND I AGREE TO PROVIDE PAYMENT FOR THESE EXPENSES.