I hereby give my permission for myself or my child to participate in activities (collectively referred to hereinafter as “camp”) organized by Crossroads Church of Douglas County, Inc. and absolve CROSSROADS CHURCH, it’s officers, employees, staff, sponsors, affiliates, licensees, vendors, and all others who may participate in the planning , organization, production, presentation and implementation of the camp, individually and collectively, from and against any and all responsibility and liability for any illness, injury, misadventure, harm, loss or inconvenience of any kind suffered or sustained as a result of, or in any way related to, participation in the camp. I understand in the event I or my child requires medical treatment while participating in the camp, reasonable efforts will be made to contact my emergency contacts designated herein below; however, I consent and give my permission to CROSSROADS CHURCH staff or any adult counselor acting on behalf of CROSSROADS CHURCH with respect to the camp, to consent to any 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 rendered, either as an outpatient or in a hospital. To the best of my knowledge, I have listed below all of my child’s allergies and medications currently prescribed or being taken, medical problems and any other pertinent information (attach additional sheets, if necessary). Finally, I hereby authorize CROSSROADS CHURCH to record and photograph (on film, tape, digital, electronic or otherwise) me or my child and to record his/her voice during the participation of camp. I hereby further authorize and agree to CROSSROADS CHURCH’s unrestricted use, reuse and distribution of said images and recordings, in whole or in part whether in the original or in the modified form, in any manner or media, including, without limitation, for purposes of advertising, promoting and publicizing CROSSROADS CHURCH, whether during or at anytime thereafter, in the sole absolute discretion of CROSSROADS CHURCH, both in the United States and internationally. I expressly and irrevocably waive any and all rights I might otherwise have, now or in the future, to any related intellectual property rights, proceeds, benefits or similar claims of any kind. I hereby release and discharge CROSSROADS CHURCH, both in the future, to any related (as defined herein above) it’s officers, employees, staff, sponsors, affiliates, licensees, vendors, and all others who may participate in the planning, organization, production, presentation, and implementation of the camp, individually and collectively, from and against any and all claims, demands, or causes of action that I may now or hereafter have in connection with or in any way related to the use and exercise the rights grated in this release and consent.
