(September 2021–September 2022)
Lifeway Church, Lebanon, PA
We (I) give permission for our (my) child to attend and participate in all activities (including any overnight activities) sponsored by Lifeway Church.
I understand that in the event medical intervention is needed, every attempt will be made to immediately contact the persons
listed in this form. In the event I cannot be reached in an emergency during the activities shown on this form, I hereby give my
permission to the physician or dentist selected by the activity leader to hospitalize, to secure x-ray examinations, to secure
medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary.
I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is
Should it be necessary for the participant to return home due to medical reasons, disciplinary action, or otherwise, I assume
responsibility for their transportation and/or all transportation costs.
Authorization and permission is hereby given to Lifeway Church to furnish any necessary transportation, food, and lodging for
I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Lifeway
Church, its leaders, employees, and volunteer staff liable for any property damages and expenses, as well as personal injuries,
death, or diseases incurred or caused by the subject of this form.
I understand all reasonable precautions will be taken at all times by Lifeway Church and its agents during the events and