General Liability & Medical Release Authorization

for all Lighthouse related activities for the 2010/2011 Academic Year

 

 General Liability Release

 

The undersigned hereby release, discharge, acquit and forgive from any and all potential actions, claims, demands, suits, judgments, liabilities, and proceedings both at law and in equity arising from and as more particularly related to any personal injury or damage to the property or person of the child(ren) named below, the undersigned parent(s), or legal guardian, resulting directly or indirectly from such child’s participation in any Lighthouse Homeschool Co-Op (hereinafter “Lighthouse”) sponsored classes or activities or unauthorized exit by the child(ren) of the building or premises. Further, the undersigned agree not to commence or maintain any suit thereon against Lighthouse or Faith Community Bible Church or any of its directors, officers, employees, representatives, or volunteers, whether at law or in equity, as a result of or in connection with any potential claim arising from personal injury or damage to the property or person of the undersigned or their child(ren).

 

The undersigned parent, or legal guardian, is fully responsible for any damage to the Faith Community Bible Church property, its contents, or another person on the property caused by any child named below.

Please Note: If you have any questions regarding the legal implications in signing this form, please be certain to consult with an attorney prior to signing.

______________________________________________________________

Signature                                                                                Date

 

 

Emergency Medical Release Authorization

 

I hereby give permission for any necessary medical attention to be administered to any child listed below in the event of an accident, injury, sickness etc. that might occur during any Lighthouse activity until such a time as I may be contacted.  I also assume responsibility for payment of such treatment.

Please Note: If you have any questions regarding the legal implications in signing this form, please be certain to consult with an attorney prior to signing.

__________________________________________________________________

Signature                                                                                                Date

 

 

Child's Name	Child's Name
DOB:	DOB:
Primary Care Physician:	Primary Care Physician:
Physician's Phone:	Physician's Phone:
Insurance Company:	Insurance Company:
Insurance Policy #:	Insurance Policy #:

I have read and understand the following:

 Lighthouse Payment Policy (initial here)_____

 

Lighthouse Parental Involvement Requirement (initial here)_____

 

Lighthouse Guidelines (initial here)_____

 

__________________________________________________________________

Signature                                                                                                Date