The safety of your child is our primary concern. While every precaution is taken for the safety and good health, some sports and activities carry with them the inherent risk of personal injury beyond the risks associated with many of the recreational activities at Plattsville Church. I/we understand and accept these risks and agree that by allowing my child to participate in this overnight retreat, he/she may be taking part in a recreational activity that presents the potential for personal injury.

I/we, the Parents or guardians named below, authorize the Pastor or one of Plattsville Church personnel to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

I/we, named below, undertake and agree to indemnify and hold blameless Plattsville Church, its personnel, its leaders and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Plattsville Church, as well as of any medical treatment authorized by the supervising individuals representing Plattsville Church.  This consent and authorization is effective only when participating in or traveling to events of Plattsville Church.

I have read, understood and agree with above.

I hereby consent to the participation of my child in this supervised activity.