PARTICIPATION, LIABILITY RELEASE, AND MEDICAL CONSENT FORM

As parent(s) or legal guardian(s), we hereby give permission for our child,

to participate in Beaches Chapel S.T.A.R.S. activities.

I, and my child, do hereby release, forever discharge, and agree to hold harmless Beaches Chapel Church and School and

the directors, employees, its agents and all other persons associated with Beaches Chapel S.T.A.R.S., from any and all

liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature

whatsoever which may be incurred by the undersigned (and the participant, if a minor) while said persons are in the care

of Beaches Chapel S.T.A.R.S. or its leaders.

I understand that, in the event my child requires medical or dental treatment while engaged in the activity, reasonable

efforts will be made to contact me. However, if I cannot be reached, I hereby consent and give permission to Beaches

Chapel S.T.A.R.S. leaders, or any adult leader acting on behalf of S.T.A.R.S., to act as an agent for me. They may consent

to any treatment and care advised and supervised by a physician, surgeon, or dentist in an emergency.

In the event of the necessity of the administration of first aid and/or a doctor’s care, or any other form of medical treatment

necessitated by illness or injury, the undersigned agrees to hold harmless and indemnify said church, it’s directors,

employees, agents, and all other persons associated with Beaches Chapel S.T.A.R.S. from any acts of malfeasance, and/or

failure to act on the part of those chosen to administer medical care on behalf of the participant.

PHOTOGRAPHIC RELEASE:

I authorize Beaches Chapel Church and School, or anyone authorized by Beaches Chapel Church and School, to use and

reproduce any and all audio and video tapes and photographs which Beaches Chapel takes of my child or any family members

produced for the school web site, literature, advertisements, and promotional purposes, without any compensation.

By Agreeing to this page you are signing this waver.