PARENT/GUARDIAN
CHILD(REN)
EMERGENCY CONTACT INFORMATION AND RELATIONSHIP
NAME(S) OF THOSE OTHER THAN PARENT/GUARDIAN WITH PERMISSION TO PICK UP CHILD:
RELEASE OF LIABILITY, PHOTO RELEASE, AND CONSENT TO MEDICAL TREATMENT
1. RELEASE OF LIABILITY:  I, the undersigned, for myself, my minor child and for the child's other parent and/or guardian, hereby release, waive, discharge, and covenant not to sue Gospel Mission Worship Center of Paducah, KY , and its officers, directors, employees, agents, volunteers, heirs and assigns of and from all liability, loss, claims, demands, possible causes of action, court costs, attorney’s fees and other expenses arising from any lawsuit that might otherwise occur from any loss, damage or injury to my child’s person or property in any way resulting from or connected with my child’s attendance at Awana, including, without limitation, the failure of anyone to enforce rules and regulations, failure to make inspections, or the negligence of other persons.
2. PHOTO RELEASE:  I, the undersigned, give permission for my child to appear in a photo or video which may be taken during Awana, to appear on Gospel Mission Worship Center's website, and/or social media page(s) or be used for publicity or display purposes. NOTE: No private information will be disclosed publicly.
3. CONSENT TO MEDICAL TREATMENT: In the event my child becomes ill or injured, I give permission for a representative of Gospel Mission Worship Center of Paducah, KY, to take whatever steps are reasonably necessary to render emergency first aid to my child. I also consent to such emergency medical treatment as may be reasonably necessary to render emergency first aid to my child. I also consent to such emergency medical treatment as may be reasonably necessary to insure the health and welfare of my child including, but not limited to, x-rays, anesthetic, medical or surgical diagnosis and treatment, hospital care and administration of drugs or medicine under the care of a licensed physician and/or surgeon.