I am the parent or legal guardian of the child listed above and warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.

As the parent or legal guardian, I certify and affirm that I have been completely and thoroughly informed that as a child attending Peace Camp at Fort Street Presbyterian Church in Detroit, my child will participate in certain activities in the church building and church grounds, and has my permission to go on outings within walking distance of the church.

I consent to my child’s participation in these activities. I acknowledge and understand that this PARENTAL AUTHORIZATION, CONSENT AND RELEASE has the same force and effect regardless of whether the activities engaged in are free or if a fee is charged. Further, I personally assume, on my child’s behalf, all risk in connection with said activities for any harm, injury, or damages that may befall my child as a result of my child’s participation in the activities, and I still wish to allow my child to proceed with the activities. In consideration of my child being allowed to participate in these activities and on behalf of my child, I herby voluntarily release, forever discharge, and agree to indemnify and hold harmless Fort Street Presbyterian Church, its staff, and volunteers from any and all claims, demands, or causes of action, which are in any way connected with my child’s participation in these activities. 

I understand that it is my obligation to inform the church of any and all health considerations or medical conditions that would restrict my child’s participation in any and all activities. Should the need for medical attention arise, the church will attempt to contact me as soon as practicable under the circumstances. 

In case of emergency, I further consent to the examination or treatment of my child by a physician duly licensed to practice medicine in the United States of America for medical care and services deemed necessary by the doctor. I give permission to the doctor or health care professional to provide any and all medical care they deem, in their professional opinion, to be necessary. I agree to pay for any and all medical expenses incurred as a result of the use of this consent. 

I acknowledge by signing this document, that if anyone is hurt or property is damaged during my child’s participation in these activities, I may be found by a court of law to have waived my right to maintain a lawsuit against the church on the basis of any claim from which I have released them herein. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions remain in full force and effect. I have fully informed myself to the contents of this PARENTAL AUTHORIZATION, CONSENT AND RELEASE by reading it before I signed it.