WPC Families & Children RELEASE FORM

FATHER/SON CAMPOUT
MAY 3-4, 2019

Name of Parent/Guardian Attending Event: ________________________________________________

Name of Child(ren) Attending Event:______________________________________________________

___________________________________________________________________________________

Address: ____________________________________________________________________________

City/St/Zip: __________________________________________________________________________

List any medical information (allergies or conditions, etc.) or circle NONE.

______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________

I desire for myself _________________________ and/or my son/ward _________________________,

_________________________, _________________________, _________________________,
_________________________ to participate in the FATHER/SON CAMPOUT 2019 and give my permission for
myself and/or him to do so. I further authorize Westminster Presbyterian Church and its volunteers, staff, and agents
to provide first aid to myself and/or my son in accord with their judgment. In the event that myself and/or my son, in
the opinion of Westminster Presbyterian Church or its volunteers, staff, or agents, needs medical care beyond first
aid, I give my consent and permission for such medical care to be obtained on behalf of myself and/or my child and
further give consent to any treatment recommended by the medical personnel consulted. I give permission for myself
and/or my child to be photographed and/or videoed and for the church to use the images as it sees fit.

I understand that the Father/Son Campout 2019 may include sports/games and/or other outdoor activities. I freely
and voluntarily assume the risk of personal injury, even if the result of the negligence of Westminster Presbyterian
Church or its volunteers, staff, or agents, and further release and hold harmless Westminster Presbyterian Church
and its volunteers, staff, and agents with respect to any and all injury, disability, death, or loss or damage to person or
property, whether caused by the negligence of the releases or otherwise.
I UNDERSTAND I AM GIVING UP IMPORTANT LEGAL RIGHTS BY SIGNING THIS DOCUMENT.

Date:_____________ Signature of Parent/Guardian Attending Event:__________________________________

____________________ _____________________
Home Phone Cell Phone Father

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Cell Phone Mother

Emergency Contact: (FIRST TO CALL): ___________________________________________________________