I certify that I am either an emancipated adult or the parent/guardian of a minor child who will be participating in the God's Word Bible Church Vacation Bible School (VBS). I am fully aware that my own/my child's participation in this event is completely voluntary. In consideration of God's Word Bible Church's agreement to allow me/my child to participate in this event, the receipt and sufficiency of which consideration is hereby acknowledged, I agree as follows:

I hereby give consent for myself and/or my child/legal ward to receive any emergency medical treatment deemed necessary by a licensed medical physician and further release God's Word Bible Church from any and all financial liabilities incurred for the medical treatment of myself and/or my child/legal ward. Furthermore, presentation of this document, displaying my original/digital signature, to the hospital and/or physician involved in the care of myself and/or my child/legal ward confirms my acceptance of the financial responsibilities incurred. I further consent to the release of any information regarding the medical treatment of myself and/or my child/legal ward to my medical insurance company and its representatives.

I agree on behalf of myself and my child named herein, to hold harmless and defend God's Word Bible Church, its officers, directors, employees, agents, chaperones, or representatives associated with God's Word Bible Church, from any claim arising from or in connection with myself and/or my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment for my child in connection therewith. I agree to compensate God's Word Bible Church or its agents for reasonable attorneys’ fees and expenses they may incur defending any such