Liability, Medical, and Media Release
I, release and hold harmless Latah Family Church (Spokane, WA) owners, officers, elected officials, leaders, employees from any and all liability, claims, demands or causes of action that I or my child may hereafter have for injuries or damages arising out of my participation in its Kids' Club activities, included, but not limited to, losses caused by the negligence of the released parties. I further agree that I WILL NOT SUE OR MAKE CLAIM against the Released parties for damages or other losses sustained as a result of any injury, or death, sustained from my participation in the Kids' Club activities. I hereby understand the potential risks involved in youth group activities and give permission for our child/youth, to attend and participate in Kids' Club sponsored by Latah Family Church.
Should it be necessary, we (I) authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care to be rendered to the minor under the general or special supervision and on the advice of any physician, licensed under the provisions of the Washington State Medical Practice Act or similar licensing laws, or the medical staff of a licensed hospital, whether such a diagnosis or treatment is rendered at the office of said physician, dentist, or at said hospital. The undersigned shall be liable and agree to pay all costs and expenses incurred in connection with any medical, dental, hospital or other services rendered to the aforementioned child pursuant to this authorization.
Should it be necessary for our (my) child/youth to return home due to medical reasons or otherwise, the undersigned shall assume all costs including, but not limited to, transportation, lodging, meals, and other related costs. The undersigned also hereby give permission for our (my) child to ride in a vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by Latah Family Church.
I authorize Latah Family Church to have the right to copyright, publish, use, sell or assign any photographs, television/videos, and sound recordings, that have been taken of my child during any/all activities, services, or broadcasts associated with Latah Family Church.
The authorizations contained in this Parental Consent Form can only be revoked in writing, signed by the persons whose signatures appear below, and hand delivered to the Pastor Seth Sasan or Pastor Darnell Simmons of Latah Family Church.