212 S. Boise Ave. Emmett, ID 83617
VALID FOR THE 2024-2025 SCHOOL YEAR*
1. I, the lawful parent or guardian, of the above named child, give permission for my child to participate in the International
Church of the Foursquare Gospel’s (I.C.F.G.) event in which he/she is registering/participating. I also agree to hold
harmless from all liability and indemnify the International Church of the Foursquare Gospel; New Life Christian Center, a Foursquare Church,
and its directors, officers, council, agents, representatives, volunteers, and employees (“church”) from any and all
liability, claims, judgments, cost or expense, including attorney fees, arising out of any damage, injury or illness incurred
or caused by my child while participating in or traveling to or from the activity, or otherwise in church custody. I
understand the risks in these activities, including the possibility of unforeseen hazards, serious injury or death. I certify
my child is able to participate in the activity.
2. I agree to instruct my child to cooperate with the church and it’s representatives in charge of the activity and understand my
child may be prohibited from participating and/or sent home for any failure to follow the rules established by the church
and/or facility in which they are attending.
3. I appoint church representatives who are acting as leaders, or designated by such leaders as my attorney in fact to act for me
in my name and my behalf, in any way that I could act if I were personally present with respect to the following matters if
any injury, illness or medical emergency occurs during the activity, related travel or while my child is in church custody.
A. To give any and all consents and authorization to any physician, dentist, hospital or other persons or institutions
pertaining to any emergency actions as our medical attorney in fact shall deem necessary or appropriate for the
best interest of the child, including but not limited to: diagnostic, treatment, operative procedures and/or x-ray
treatment.
B. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above named
student.
C. I understand the church will make a reasonable attempt to contact me as soon as possible in the event of a
medical emergency involving my child.
D. I have not been given guarantee as to the results of examination or treatment. I have included medical insurance
information in which to pay for necessary care.
4. I understand that the church’s insurance is secondary to my own primary coverage, which I am responsible.
5. I agree that the church may use my child’s and or my own name, voice, portrait, photograph or image for promotional
website, office or any other church related purpose. These may be used in any broadcast, telecast, digital or print medium,
including video images, photographs, pictures or renderings, audio recordings, or other likenesses, in combination or alone.
I will notify the church immediately of any change in the information presented and agree it is valid until revoked in writing
by me. I have carefully read this statement, and my signature acknowledges that I fully understand the content and meaning.
* 2024-2025 School Year constitutes September 1, 2024 through August 31, 2025
