Please list the name of the nearest relative/neighbor to be contacted in case of an emergency if you cannot be located

Release and Hold Harmless Agreement for Aldersgate Church

By my signature, I, the parent or guardian of child/children listed on this form, grant my permission for him/her to participate fully in any Sunday activities, midweek activities or trips sponsored by Aldersgate Church. I understand that my signature carries with it the following:

- An authorization of any of the adult leaders to obtain necessary medical attention and/or treatment for my son/daughter.

- The release of medical information necessary to provide treatment.

- I knowlingy release, absolve, indemnify and hold harmless Aldersgate Church from all claims that might result from an injury or death of a minor. This agreement pertains to all programs and activities including those where transportation is provided.

- Should medical help be needed, I agree to pay, directly or through my own personal health and accident insurance policy, all medical or hospital costs.

I give my permission for the above named child/children to be in pictures taken related to Sunday or midweek activities or trips sponsored by Aldersgate Church used for historical and promotional purposes, and that may be placed on the church's website and Facebook pages.