PACHEK
PARENTAL PERMISSION AND MEDICAL CONSENT WITH LIABILITY RELEASE
The undersigned(s), being the lawful parent(s) and/or guardian(s) of the child/ren,(the "Child") listed in parent registration with PACHEK, hereby consents to the participation by the Child in any event hosted or sponsored by Pennyroyal Area Christian Home Educators of Kentucky, (name of “Organizer”), and to the participation of the Child in all events relating to the Activity.
In consideration of participating in any Pennyroyal Area Christian Home Educators of Kentucky event, I represent that I understand the nature of this Activities and Events hosted by PACHEK and that I am physically qualified and able to participate in said events that I sign up for to include any family event, club, field trip, sport, co-op class or special event hosted by PACHEK. I fully understand that this Activity involves risks of serious bodily injury, including permanent disability, paralysis, and death, which may be caused by my own actions, or inactions, those of others participating in the activity, the conditions which the activity takes place, or the negligence of the "releases" names below; and that there may be other risks either not known to me or not readily foreseeable at this time: and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my participation in this Activity.
Medical Consent
The undersigned hereby further authorizes that in the event of parent or guardian not being in attendance of said event, any of the staff, employees, agents, and representatives of Organizer to provide for, approve and authorize any health care at any hospital, emergency room, doctor's office or other institution; employ any physicians, dentists, nurses or other person whose services may be needed for such health care form required by medical, dental or other health authorities incident to the provision of medical, surgical or dental care to the child. Health care should include the provision of medical, surgical or dental care to the child. Health care shall include but not be limited to, administration of anesthesia, X-ray examination, performance or operations, diagnostic and other procedures. The parent or guardian agrees to not hold PACHEK liable for any said injuries.
If there is no medical emergency, the staff will first use reasonable efforts to contact the parent(s) and/or guardian(s) before administering or authorizing any treatment. Notwithstanding other provisions in the Consent Form, Organizer shall not have the authority to withhold or withdraw life-sustaining procedures for the Child.
If parent/guardian of the child is in attendance for said event/s, parent/guardian assumes full responsibility for any health care needed due to injury or incident. Parents/guardians are responsible for providing insurance information and assume any financial cost associated with health care received. PACHEK will not assume any responsibility for health care due to injury or incident.
I hereby release, discharge, and covenant not to sue Pennyroyal Area Christian Home Educators of Kentucky. AKA: PACHEK, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place, (each considered on of the "Releases:" herein) from all liability, claims, demands, losses or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the "releases" or otherwise, including negligent rescue operation and further agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releases, I will indemnify, save and hold harmless each the Releases from any loss, liability, damage, or cost, which any may incur as the result of such claim.
Parental Consent
AND I, the minor's parent and/or legal guardian, understand the nature of the above referenced activity and the Minor's experience and capabilities and believe the minor to be qualified to participate in such activity, assume(s) all risk of injury or harm to the Child associated with participation in the Activity. I hereby Release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releases from all liability, claims, demands, losses or damages on the minor's account caused or alleged to have been caused in whole or in part by the negligence of the Releases or otherwise, including negligent rescue operations and further agree that if, despite this release, I the minor, or anyone on the minor's behalf makes a claim against any of the above Releases, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releases from any litigation expenses, attorney fees, loss liability, damage, or cost any Release may incur as the result of any such claim, how so ever caused, arising or to arise by reason of or during the Child's participation in the Activity.
PENNYROYAL AREA CHRISTIAN HOME EDUCATORS OF KENTUCKY
Safety is our top priority while enjoying events in a fun atmosphere. The volunteers at Pennyroyal Area Chrisitan Educator of Kentucky work hard to provide a safe environment for our children.
We are asking that you please read and sign the following:
- I understand that this is NOT a child care service, or school
- I understand that I must stay with the group and the activity in which they are participating
- I understand that I am responsible for the behavior and physical wellness of my child/ren
- I understand that I am responsible for reviewing and consenting to all forms, rules and regulations within any PACHEK event
- I understand that if I do not abide by these rules I may not be allowed to continue to participate
I have read and agree to abide by the procedures and rules of Pennyroyal Area Christian Home Educators of Kentucky as stated above and on the consent form.
