I hereby release The Church at Creek’s End their staff and sponsors, from responsibility and liability for any injury or illness that my child may sustain during activities sponsored by said churches. Furthermore, I authorize said churches and sponsors, as agent for me, to consent, with regards to my child, to an X-RAY examination, medical, dental, or surgical diagnosis: treatment: and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are being rendered, either at a doctor’s office or in any hospital. I expect to be contacted as soon as possible.
Parent/Guardian signature: ____________________________________________________________________________
(Please print and sign this document and turn it in to Pulse team)