If You Would Like to Receive Emails About Quest, Please Put Your Name and Email Address Below

September 2013 – September 2014

If you would like to receive emails about Quest, please put your name and email address below:

Parent Name: ______EmailAddress ______

MEDICALRELEASE: By signing below, as the parent or legal guardian, having legal custody of the above named youth, I give permission for a licensed doctor, physician, or emergency treatment center, selected by the person in charge of any Parkway Community Church event, to administer the necessary attention and aid immediately to our child should he/she become injured or sick at any event during the dates of September 1, 2013- September 30, 2014 and to do so without having to wait until I have been contacted. I furthermore understand that I will be held liable for the expense of that treatment. I consent to X-rays, examination, anesthetic, medical or surgical diagnosis, treatment, and hospital care. I understand the event leader will endeavor to reach us should the nature of the injury or illness warrant it. However, we will not hold any of the event personnel responsible if efforts to contact me are unsuccessful.

By signing below, the participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of physical injury associated with participation with activities sponsored by Parkway Community Church. Except for gross negligence on the part Parkway Community Church, the participant‘s parent/guardian accepts personal financial responsibility for any bodily or personal injury sustained during the activity. Further, the participant (or parent/guardian) promises to hold harmless Parkway Community Church and its representatives for the any injury related to the activity. If a dispute over the agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable arbitration process.

By signing below, I also authorize, in advance, the PCC leaders to give my son/daughter Tylenol (or similar pain medication) if, in the opinion of the adult leaders of the activity, my child is in need of such over-the-counter medication. (Strike out this paragraph and initial if not authorized.)

DISCIPLINARY/SEARCH RELEASE: By signing below, I agree to pay any expense including the cost of my son/daughter being sent home if discipline is deemed necessary. I further understand that in the interests of providing necessary accountability to my child, the attending Pastor may search my child’s belongings if there is reasonable suspicion that any prohibited items have been brought by my child. I also understand that the Pastor will always act in the best interest of any student by handling any search quietly and discretely with at least one other Youth Staff member present. In the event any of the prohibited items are found, the Pastor will, after conferring with the Executive Pastor, make a decision regarding the best course of action for the emotional and spiritual growth of my child and the other students present.

PHOTOGRAPHY RELEASE: By signing below, I hereby give Parkway Community Church the right to record photographs and video footage of my child(ren) and to use, re-use, publish and re-publish in whole, or in part for any purpose, including, but not limited to illustration, training or promotion. I hereby release and discharge Parkway Community Church from any and all claims, and demands arising out of or in conjunction with the use of the images. (Strike out this paragraph and initial if not authorized.)

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Parent/Guardian Printed Name Parent/Guardian Signature Date