4CM Waiver Form - CA Identity Retreat 2015
I hereby consent to the performance of any examination, medical emergency treatment, anesthetics, surgical treatment, and/or hospital care deemed necessary by an attending physician or surgeon licensed under the provision of the Medical Practice Act (applicable in U.S.) on behalf of the person(s) whose name(s) appear below. If the below person(s) is(are) under the age of 18, I give this consent as a parent of guardian of the named person(s). I realize that this authority is for the administering of medical treatment within the United States and within Mexico.
I also fully understand that any travel, activity, or outdoor pursuit have inherent dangers that no amount of care, caution, instruction, or expertise can eliminate. Mindful of these conditions, I hereby forever release and discharge 4 Christ Mission and its directors, officers, employees, agents, trip organizers, and volunteers from all liabilities, any losses, claims, demands, causes of actions, or whatsoever arising out of my child(ren)'s participation in IDENTITY RETREAT 2015 or improper medical treatment recommended by physician(s), clinic(s), or hospitals received/outside the United States. I accept responsibility for any financial cost incurred by the named person but not covered by medical insurance while in this conference. If the named person does not have medical coverage, I take responsibility for cost(s) incurred for medical procedures for such person(s) while in this event.
I expressly and voluntarily assume all risk, personal injury, or property damage sustained by me/my child(ren) while participating in IDENTITY RETREAT 2015 and agree for myself, my child(ren) and my heirs, representatives and assigns to indemnify and hold harmless 4 Christ Mission and its directors, officers, employees, agents, trip organizers, and volunteers for any and all losses, claims, actions, or proceedings of any kind which may be initiated by myself, my child, or any other person or organization including demands for damages, judgments, costs, losses for services, or expenses, arising from the activities contemplated by this consent, including but not limited to reasonable attorney feed incurred by 4 Christ Mission.