8205 Highway 161 N, North Little Rock, AR
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Student Lockout Consent Form
Student's Contact Number
Parent/Guardian's Contact Number
Function and Activities
It is my understanding that participating in the programs and recreational activities of St. Luke Baptist Church is a privilege. Prior to my participation in such activities, I acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity related accidents, physical injury due to transportation related accidents, illness, or even death. I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.
Release of Liability
By signing this Permission/Waiver Form, I expressly warrant that the child named above is capable of withstanding both the physical and mental demands of the activities discussed above. I also expressly assume all risks of the child participating in the activities, whether such risks are known or unknown to me at this time. I further release St. Luke Baptist Church and its ministers, leaders, employees, volunteers, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall exclude any gross claims of negligence. This release of liability is also intended to cover all claims that members of the child's or my family or estate, heirs, representatives, or assigns may have against St. Luke Baptist Church or its ministers, leaders, employees, volunteers, or agents.
First Aid Emergency Treatment
I recognize that there may be occasions where the child named above may be in need of first aid or emergency medical treatment as a result of accident, illness, or other health condition or injury. I do hereby give permission for agents of St. Luke Baptist Church to seek and secure any needed medical attention or treatment for the child named above, including hospitalization, if in the agent's opinion such need arises. In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment.
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