9800 SE 92nd Avenue • Happy Valley • OR • 97086 • (503) 788-7000
Sunday Service: 9:00 a.m. - Classes for all ages: 10:30 a.m.
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Medical Release/Code of Conduct Form
I give permission for the listed student to attend:
Family Fun Center 2015
I (we) give permission for the above named to attend Beautiful Savior Lutheran Church’s event listed below. I (we) give permission for my (our) child to participate in all activities during this event. I (we) do hereby release, forever discharge and agree to hold harmless Beautiful Savior Lutheran Church located at 9800 S.E. 92nd Ave., Portland, OR 97086, along with the directors and chaperon's thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above described trip.
Furthermore, I (we) on behalf of my (our) child-participant hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. Further authorization and permission is hereby given to Beautiful Savior Lutheran Church, and its chaperon's for said trip to furnish any necessary transportation, food, lodging, and equipment rental for this said participant.
I (we) am the parent(s) or legal guardian(s) of this participant, and hereby grant my (our) permission for him (her) to participate fully in said trip, and hereby give my (our) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, and assume the responsibility of all medical bills, if any, as described on said church’s Eyewitness Health History Form.
Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I (we) hereby assume all transportation costs.
Parent/Guradian E-Signature (Full Name & DOB 00/00/0000)
Type full name and date
Rules of conduct:
1) Build up, don’t tear down. 2) Respect people and their property. 3) The use of drugs, alcohol, and tobacco products are prohibited. 4) Bible width. If you can get any size Bible between you and a significant other...you are good.
I have read the forgoing and understand the rules of conduct for participants and will abide by them as well as other directions of the leadership and chaperon's on the trip.
Signature of Participant (Full Name & DOB 00/00/0000)
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