Emergency Contact

IN CASE I AM UNABLE TO SIGN OR GIVE VERBAL CONSENT IN AN EMERGENCY, I HEREBY AUTHORIZE the administration of any medical treatment deemed necessary by Harbor Church Staff and/or any physician licensed under the provisions of the Medical Practice Act on the staff of a licensed hospital.  

Authorization for Minor Child:  IN CASE MY CHILD REQUIRES EMERGENCY MEDICAL TREATMENT I UNDERSTAND THAT I WILL BE CONTACTED IMMEDIATELY.  I represent that I am the parent or Legal guardian of the Participant named on this form.  I HEREBY AUTHORIZE the administration of any medical treatment deemed necessary by Harbor Church Staff and/or any physician licensed under the provisions of the Medical Practice Act on the staff of a licensed hospital.  I HEREBY GRANT PERMISSION TO HARBOR CHURCH FOR MY CHILD TO PARTICIPATE IN THIS EVENT.

I REALIZE THAT INSURANCE PROTECTION IS MY RESPONSIBILITY.


Waiver of Liability:

I hereby fully release Harbor  Church, religious corporation of the State of California, its trustees, staff, members of the Board, and/or any adult leaders, whether volunteer or professional, from all liability for any accident(s), injury(s), and/or death caused to myself that may come from my voluntary participation in athletic, recreational, social, transportation and/or any other activity sponsored by Harbor  Church. By signing this agreement, I state that I fully understand it and this Waiver of Liability shall bind my heirs, executors, administrators, assigns and/or any other persons having control over my affairs.


Photo Release:

It is my understanding that Harbor may take digital pictures at various activities and events and I understand that Harbor may use the images in any media for any purpose which may include, among others, advertising, promotion, marketing and packaging for any product or service.  I agree that the images may be combined with other images, text and graphics, and cropped altered or modified.  I hereby acknowledge and agree for Harbor to use pictures/videos of me/my child for these purposes.

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