Medical/Liability Consent Policy
"...I pray that you may enjoy good health and that all may go well with you..." - 3 John 1:2
Medical/Liability Consent Policy
This consent form gives permission to seek whatever medical attention is deemed necessary, and releases La Casa de Cristo Lutheran Church (hereafter named “the Church” or “LCDC”) and its staff of any liability against personal losses of named participant.
I/We the undersigned have legal custody of the participant named above, a minor, and have given our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our participant’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent.
I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the participant named above. I/we also agree to bring my/our participant home at my/our own expense should they become ill or if deemed necessary by the La Casa de Cristo Staff.
Parent/Guardian Agreement: Health and Physical Condition – I hereby agree, warrant and represent that I am the parent or legal guardian of the Participant; the Participant is in good health and in proper physical condition to participate in the Church Event; and the Participant is not under the influence of alcohol or of illicit or prescription drugs which may impair the Participants ability to safely participate in the Church Event.
Voluntary agreement to limit claims for negligence to the amount of applicable insurance from negligence, gross negligence, strict liability, derivative liability or otherwise, including injury, accident, sickness and accident losses. I understand these trips include but are not limited to; travel by car, van, bus, or airplane, and have activities such as sports, games, adventure sports, etc. I, the parent and or legal guardian agree to permit the Participant to participate in the Church Event and agree to voluntarily limit their claims for damages to the amount of applicable insurance. All losses or expenses in excess of the amount of applicable insurance must be borne by Participant and or Guardian.
Thus, if injured and intend to assert a claim against La Casa de Cristo Lutheran Church, then I will look first to my own insurance company for coverage. I will then look to the applicable insurance carried by La Casa de Cristo Lutheran Church, but only to the extent of applicable limits. As a condition, participant and or Guardian agree that Participant and or Guardian freely and voluntarily waive all rights to assert a claim or judgment against the assets of La Casa de Cristo Lutheran Church and its affiliates in excess of their applicable insurance coverage.
Indemnity for La Casa de Cristo Lutheran Church – To the extent Participant and Guardian have applicable insurance coverage, they will indemnify, protect, defend, and hold La Casa de Cristo Lutheran Church harmless for, from and against all cost, claims, and charges arising from the Church Event whether caused by La Casa de Cristo Lutheran Church, its employees, independent contractors, volunteers or otherwise.
Media Permission – The Participant and Guardian hereby grant a license and permission to La Casa de Cristo Lutheran Church or their designees, and their employees, successors, assignees, licensees, and agents to utilize the Participant and Guardian appearance, image, voice and likeness, in perpetuity, in any manner and form and format of media throughout the world, now know or hereafter devised, including but not limited to photographs, video, recordings, broadcast, or web-casts of the event attending.
Participant Code of Conduct: These standards apply to ALL Participant Church gatherings at LCDC as well as ALL Participant Church retreats, camps, and sponsored events.
Rules and Conduct – Participant understands and is expected to conform to the following rules and conduct; the use of tobacco, alcohol, vape, and drugs is strictly prohibited. Possession or use of weapons, knives, firearms, or fireworks is strictly prohibited. No offensive or immodest clothing. No boys in girls’ sleeping quarters and no girls in boys’ sleeping quarters. No participant can drive other participants on an activity. Participation with the group is expected. Show respect of all property, one another, staff, and adult leaders. Respect and comply with Church event schedules. Violation will result in immediate dismissal without refund.
Participants who fail to comply with these expectations may be sent home at their parents’ expense.