Agreements

NorthPointe Community Church, NorthPointe Student Ministries, and Volunteers Are Designated By The Abbreviation “NP” Throughout This Entire Form

I (we) hereby give permission for my (our) child to attend and participate in activities sponsored by NP.
I (we) hereby authorize NP to transport my (our) child to or from church and/or any other church related and sponsored activities.
I (we) hereby authorize NP to include my (our) child in supervised water activities.
I (we) hereby authorize NP and its acting leaders to teach and lead my (our) child in religious lessons and services which may include prayer and Bible teaching.
I (we) hereby authorize the volunteer medical staff and Campus Safety Team, 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 or dentist licensed under the provisions of the medical practice act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at the said hospital.
I (we) hereby do authorize any leader of NP to dispense to my (our) child any necessary over-the-counter medications (according to proper dosage instructions) when deemed necessary.
I (we) do hereby authorize any licensed physician or medical treatment center to treat my (our) child in the case of an emergency.
The undersigned adult shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.
Should it be necessary for my (our) child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs.
I (we) hereby release, forever discharge and agree to hold harmless NP and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned adult and the child-participant that occur while said child is participating in any trip or activity with NP.
Furthermore, I (we) [and on behalf of my (our) child-participant if under the age of 18 years] hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation in recreation and work activities involved therein.
Further authorization and permission is hereby given to said church to furnish any necessary transportation, food, and lodging for this participant.
The undersigned further hereby agrees to hold harmless and indemnify said church, its directors, employees, and agents for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.
The medical consent and liability waiver provisions hereof shall remain in full force throughout 2017 and in effect until written notice of revocation or withdrawal is received by NP at its office. It is the responsibility of the parent or guardian to notify the church of any changes in medical condition, guardianship, address or phone change in writing to the address listed at the beginning of this form.

JH Hume Lake- Winter Camp 2027