Cornerstone Church

has my permission to participate in Cornerstone Students Pool Party on June 13 from 2-5pm at 41 Deer Hill Road In Gardner MA. In consideration of the benefits to be derived from these activities, I hereby voluntarily waive any claim against Cornerstone Church, the sponsors, and the owner/or driver of the car or church vehicle furnishing transportation to this event. I further agree to direct my son/daughter to conform to the fullest with the directions and instructions of the sponsors in charge. I also understand that no drinking, smoking, sexual conduct, or use of drugs is permitted on this church trip and that a violation of any of these will result in the immediate return home, at my expense.

CONSENT TO TREAT A MINOR Being the parent or legal guardian of above-mentioned youth(s), I do consent to any x-ray, anesthetic, medical, surgical, or dental diagnosis or treatment that may be deemed necessary for my minor child(s). Further, I understand that all efforts will be made to contact me prior to treatment. In the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child(s). I further understand that the doctors, dentists, and other providers attending to my child will take all reasonable safety precautions during their care. Further, as parent or legal guardian I am responsible for the health care decisions for my minor child(s) and agree that my insurance plan is the primary plan to pay for the dental, medical, or hospital care or treatment that is given to my child.