Please list other adults besides those listed above who have permission to pick up child. If none, please just mark NA.
I hereby authorize Henderson Avenue Baptist Church, through the adult person into whose care my child has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care for him/her, under supervision of and as deemed advisable by a physician licensed under the Medicine Practice Act. It is understood that this authority is given in advance of the need for any diagnosis, treatment or hospital care, but is to provide authority for said adult person pursuant to Section 25.8 of the California Civil Code. I approve of my child's participation in Henderson Avenue Baptist Church Adventure Club, and release Henderson Avenue Baptist Church, and church leaders/workers of any liability in case of accident, illness, injury, or death while on church premises or during a church sponsored event off church premises.
I hereby give consent to Henderson Avenue Baptist Church or HABC (the “organization”) to photograph, videotape, or otherwise digitally record and use images and/or sound recordings of my child to use in any public media, including radio, television, internet, social media, print, or in any of the organization’s publications, productions, or posts. I understand that the intended use of such images and information is solely for the purpose of advertising, marketing, fundraising and/or the promotional and public awareness purposes for the organization. I hereby waive any rights or interest in the images or recordings, as contemplated in this release.
I acknowledge that this consent to use images and/or recordings is being made solely for the benefit of the organization and comes without any expectation of monetary compensation or other benefit to me. To the extent that any benefit accrues or might accrue to the organization from the use of images or information, I hereby and forever waive any interest in or claim to such benefits.
I hereby release and forever discharge the organization (including without limitation all corporate affiliates and officers, directors, trustees, doners, employees, agents and volunteers) from any and all claims, liability, actions, suits, demands, costs, expenses or indebtedness arising out of, related to, or in any way connected with the use of images and materials described herein, and I hereby waive all rights and interest in and to such information and materials.
I further acknowledge that there is no guarantee that any or all of the participants’ images or recordings will be used in any released media.
I have been informed that this authorization is voluntary and is subject to revocation at any time, except to the extent that action has been taken in reliance thereon, by notifying the organization in writing at: 1876 W. Henderson Avenue, Porterville, CA 93257