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K-5th Grade Mother/Son Cowboy Breakfast on Saturday, February 29, 2020 @ 4:00 PM

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Join us for a K-5th grade Mother & Son Cowboy Breakfast
Calling all cowboys kindergarten through 5th grade! Round up your mom, grandmother, or mother figure and join us for a fun-filled evening. There will be a bonfire, breakfast for dinner, and games on the Avon Side Lawn by the GaGa Pit. Our rain location will be the IPC Gym. Wear your best western attire!

Please fill out this form in its entirety to register your son for the Cowboy Breakfast scheduled for Saturday, February 29, 2020 from 4:00 to 6:00 p.m.

By registering me and/or my child, I understand that IPC may use pictures that include me and/or my child on the church website and other in-house communications; however, no personal information identifying the children or adults will appear with those pictures.
*Child's Full Name:
*Child's Grade:
*Child's Date of Birth:
*Age:
MINOR RELEASE OF LIABILITY, INDEMNITY AGREEMENT, AND CONSENT TO MEDICAL TREATMENT
I hereby give my permission for my child to participate in the Mother/Son Cowboy Breakfast on February 29, 2020, 4:00 p.m. - 6:00 p.m. at Independent Presbyterian Church (the "Event"). I certify that my child is healthy and capable of participating in the Event, or that I have communicated any medical conditions of which Independent Presbyterian Church ("IPC") should be aware that may hinder my child' s participation in the Event. I understand that it is solely my responsibility to determine if there is any medical reason that my child should not participate in the Event. In consideration for IPC allowing my child to participate in the Event, I hereby, on behalf of myself and on behalf of my minor child, release, discharge, waive my right to sue, and agree to indemnify and hold harmless IPC, its directors, officers, staff, employees, volunteers, agents, and third party contractors, from any and all legal claims, liabilities, losses, expenses and demands of any nature whatsoever arising out of the Event, including those related to personal injury, sickness, harm, death, or property damages suffered by my child or me as a result of, or arising in any way out of, my child 's participation in any of the Event. Furthermore, I acknowledge that there are risks involved in participating in the Event, and I hereby, on behalf of my minor child, assume all risk of personal injury, sickness, death, damage and expense arising out of or related to my child's participation in the Event. :
I hereby authorize IPC and its staff, employees, volunteers, agents, and third-party contractors to provide necessary transportation and food for my child 's participation in the Event. In the event of a medical emergency, I understand that IPC will make reasonable efforts to contact me or my child's emergency contacts, however: (I) I authorize IPC and its staff, employees, or volunteers to administer first aid or CPR to my child, if they think it is necessary; (2) I authorize IPC and its staff, employees, or volunteers to administer appropriate medication to my child if they deem it necessary, except for any medications I have listed below, to call for emergency treatment, if necessary, to transport my child to a medical treatment facility, and to consent if I or the emergency contacts cannot be reached to X-rays, medical or dental examination, diagnosis, treatment, or hospital care, including emergency surgery, as advised by the treating physician, surgeon, or dentist; and (3) I authorize IPC and its staff, employees or volunteers to disclose any relevant medical information about my child as necessary for his/her treatment. I understand that I will be solely responsible for any medical, hospital or related charges, which may be incurred on behalf of my child in connection with any injury, illness or other medical condition suffered by him/ her during this Event. Upon request, I will reimburse IPC for any charges paid by them on my child 's behalf. :
I also authorize IPC, its staff, employees, and volunteers to photograph or digitally record images of my child and to record my child's voice during his/her participation in the Event; and I authorize IPC to use such photos, images or recordings for any purpose relating to the IPC Children’s Ministry. I waive any and all privacy or intellectual property rights I or my child may have with respect to any such photos, images, or recordings, and release IPC and its directors, officers, staff, employees, volunteers, agents, and third party contractors, from any and all legal claims, demands, or causes of action, of any nature whatsoever, relating to photos, images, or recordings taken of my child pursuant to this authorization.:
Child's Allergies:
Does your child have any medical condition that we should be aware of that may hinder his participation in this event, or is your child allergic to any medications? :
*Yes/No:
If yes, please explain:
The signer states on oath that he or she is the parent(custodial parent if divorced or separated) or legal guardian of the Participant and intends to be bound by this signature. :
*Signature:
*Relationship:
*Today's Date :