Common use of Authorization for Emergency Clause in Contracts

Authorization for Emergency. Medical Treatment I have listed above my or my child’s physical conditions or medical problems that may need attention and all medications regularly used by myself or said minor. I understand failure to disclose medical information/condition may result in dismissal from Longbranch Community Baptist Church. In case of the illness of myself or my child, Longbranch Community Baptist Church will try to notify whoever is listed as the emergency contact person. In the event there arises a medical emergency concerning myself or my child, at a time where the emergency contact cannot be notified, I authorize Longbranch Community Baptist Church to consent to any necessary X-ray examination, anesthetic, medical or surgical diagnosis or treatment, or hospital care. I hereby consent and give my permission to the Longbranch Community Baptist Church staff or any attending physician to make such decisions and to perform such medical treatments and/or surgery upon myself or my child that may, in their sole discretion, be necessary and proper under the circumstances. General Release and Waiver of Liability I DO RELEASE, ACQUIT, DISCHARGE, AND COVENANT TO HOLD HARMLESS Longbranch Community Baptist Church STAFF, PERSONNEL, OR ANY OF ITS REPRESENTATIVES FROM ANY ACTIONS, DAMAGES, OR LIABILITIES ARISING OUT OF ANY INJURIES OR PROPERTY DAMAGE SUSTAINED DURING THE PARTICIPATION IN THE CAMP AND/OR RESULTING FROM THE TREATMENT OF ANY ILLNESS, SICKNESS, OR ACCIDENT, INCURRED BY MYSELF OR MY CHILD DURING HIS/HER STAY AT Longbranch Community Baptist Church. In consideration for being permitted to attend Longbranch Community Baptist Church and participate in the activities conducted by the Camp, I, on behalf of myself, my child, my legal representatives, heirs and assigns, do hereby release, waive, and forever discharge Longbranch Community Baptist Church and its officers, employees, volunteers, and agents, of and from any and all loss, damage, claim, demand, action or right of action, of whatever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death or property damage resulting or to result from any accident that may occur as a result of my or my child’s participation in the camp activities or any activities in connection with the Longbranch Community Baptist Church, whether by negligence or not. I, personally, and on behalf of my child (if child is the camp participant), hereby give Longbranch Community Baptist Church permission to use my and/or my child’s name, photograph, quotations and likeness in any advertisements or promotions performed in connection with the camp and agree that neither I nor my child shall be entitled to any compensation for such use. I agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that if any portion of this agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. X Adult Participant or Parent/Guardian Signature Printed Name and Address of Signatory:

Authorization for Emergency. Medical Treatment I have listed above my or my child’s physical conditions or medical problems that may need attention and all medications regularly used by myself or said minor. I understand failure to disclose medical information/information and/or condition may result in dismissal from Longbranch Community Baptist ChurchKids Life Xxxx (TEBA)/Carolina Creek Christian Camp. In case of the illness of myself or my child, Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp will try to notify whoever is listed as the emergency contact person. In the event there arises a medical emergency concerning myself or my child, at a time where the emergency contact cannot be notified, I authorize Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp to consent to any necessary X-ray examination, anesthetic, medical or surgical diagnosis or treatment, or hospital care. I hereby consent and give my permission to the Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp staff or any attending physician to make such decisions and to perform such medical treatments and/or surgery upon myself or my child that may, in their sole discretion, be necessary and proper under the circumstances. General Release and Waiver of Liability I DO RELEASE, ACQUIT, DISCHARGE, AND COVENANT TO HOLD HARMLESS Longbranch Community Baptist Church KIDS LIFE XXXX (TEBA)/ CAROLINA CREEK CHRISTIAN CAMP STAFF, PERSONNEL, OR ANY OF ITS REPRESENTATIVES FROM ANY ACTIONS, DAMAGES, OR LIABILITIES ARISING OUT OF ANY INJURIES OR PROPERTY DAMAGE SUSTAINED SUTAINED DURING THE PARTICIPATION IN THE CAMP AND/OR RESULTING FROM THE TREATMENT OF ANY ILLNESSILNESS, SICKNESS, OR ACCIDENT, INCURRED BY MYSELF OR MY CHILD DURING HIS/HER STAY AT Longbranch Community Baptist ChurchCAROLINA CREEK CHRISTIAN CAMP, EVEN IF SUCH INJURIES OR DAMAGES ARE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE (BUT NOT GROSS NEGLIGENCE OR RECKLESSNESS) OF KIDS LIFE XXXX/CAROLINA CREEK CHRISTIAN CAMP, ITS OFFICERS, AGENTS, EMPLOYEES OR PARTICIPANTS. In consideration for being permitted to attend Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp and participate in the activities conducted by the Camp, I, on behalf of myself, my child, my legal representatives, heirs and assigns, do hereby release, waive, and forever discharge Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp and its officers, employees, volunteers, and agents, of and from any and all loss, damage, claim, demand, action or right of action, of whatever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death or property damage resulting or to result from any accident that may occur as a result of my or my child’s participation in the camp activities or any activities in connection with the Longbranch Community Baptist ChurchKids Life Xxxx (TEBA)/Carolina Creek Christian Camp, whether or caused in whole or in part by the negli- gence (but not gross negligence or notrecklessness) of Kids Life Xxxx (TEBA) /Carolina Creek Christian Camp, its officers, agents, employees or participants. Miscellaneous Provisions I, personally, and on behalf of my child (if child is the camp participant), hereby give Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/ Carolina Creek Christian Camp permission to use my and/or my child’s name, photograph, quotations and likeness in any advertisements or promotions performed in connection with the camp and agree that neither I nor my child shall be entitled to any compensation for such use. I agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that if any portion of this agreement is held invalid, it is agreed that the balance shall, notwithstandingnot withstanding, continue in full legal force and effect. Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp is authorized to provide or obtain medical care for me or the child, as it deems appropriate, and to exchange medical information with third party care givers. To the extent a claim asserted against a Released Party by a camper or other visitor or Parent shall be brought exclusively in Walker County, Texas, and the laws applicable thereto shall be those of the State of Texas, not including those laws which may apply the laws of another jurisdiction. This Agreement may be amended only by a written instrument, signed by the parties hereto. STUDENT OR SPONSOR T-SHIRT SIZE YM AS YL AM AL AXL A2XL A3XL This Agreement is intended to be binding upon my, and the child’s, heirs, estates, executors, guardians, administrators, legal representatives and assigns. X Date: X Adult Participant or Parent/Guardian Signature Printed Name and Address of Signatory: Authorization for Emergency Medical Treatment General Release and Waiver of Liability Miscellaneous Provisions Medication Administration Record • ALL MEDICATIONS MUST BE IN THE ORIGINAL CONTAINER WITH PHYSICIAN’S INSTRUCTIONS. OTC MEDS MUST BE IN ORIGINAL MANUFACTURER PACKAGING. MEDS IN UNMARKED PACKAGING WILL NOT BE ADMINISTERED. • Meds will not be given to minors without a sponsor present. Meds will be given to sponsors to dispense. • Please place medication bottles in a Ziploc bag clearly labeled with child’s first and last name. • Primary dispensing times for medications will be at each meal unless otherwise noted by a physician. • Medication must be turned in to medical personnel upon arrival at camp for security purposes. NO medications (prescribed or OTC) or vitamins are allowed to be kept in the cabins. • Please circle at which meal your child takes his/her medication. • Fill out shaded column only; daily columns are for the medical personnel use only. Camper Name: DOB: M/F: Parent/Guardian Name: Phone Number: Medical Allergies: Parent/Guardian Signature:

Authorization for Emergency. Medical Treatment I have listed above my or my child’s physical conditions or medical problems that may need attention and all medications regularly used by myself or said minor. I understand failure to disclose medical information/information and/or condition may result in dismissal from Longbranch Community Baptist ChurchKids Life Xxxx (TEBA)/Carolina Creek Christian Camp. In case of the illness of myself or my child, Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp will try to notify whoever is listed as the emergency contact person. In the event there arises a medical emergency concerning myself or my child, at a time where the emergency contact cannot be notified, I authorize Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp to consent to any necessary X-ray examination, anesthetic, medical or surgical diagnosis or treatment, or hospital care. I hereby consent and give my permission to the Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp staff or any attending physician to make such decisions and to perform such medical treatments and/or surgery upon myself or my child that may, in their sole discretion, be necessary and proper under the circumstances. General Release and Waiver of Liability I DO RELEASE, ACQUIT, DISCHARGE, AND COVENANT TO HOLD HARMLESS Longbranch Community Baptist Church KIDS LIFE XXXX (TEBA)/ CAROLINA CREEK CHRISTIAN CAMP STAFF, PERSONNEL, OR ANY OF ITS REPRESENTATIVES FROM ANY ACTIONS, DAMAGES, OR LIABILITIES ARISING OUT OF ANY INJURIES OR PROPERTY DAMAGE SUSTAINED SUTAINED DURING THE PARTICIPATION IN THE CAMP AND/OR RESULTING FROM THE TREATMENT OF ANY ILLNESSILNESS, SICKNESS, OR ACCIDENT, INCURRED BY MYSELF OR MY CHILD DURING HIS/HER STAY AT Longbranch Community Baptist ChurchCAROLINA CREEK CHRISTIAN CAMP, EVEN IF SUCH INJURIES OR DAMAGES ARE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE (BUT NOT GROSS NEGLIGENCE OR RECKLESSNESS) OF KIDS LIFE XXXX/CAROLINA CREEK CHRISTIAN CAMP, ITS OFFICERS, AGENTS, EMPLOYEES OR PARTICIPANTS. In consideration for being permitted to attend Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp and participate in the activities conducted by the Camp, I, on behalf of myself, my child, my legal representatives, heirs and assigns, do hereby release, waive, and forever discharge Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp and its officers, employees, volunteers, and agents, of and from any and all loss, damage, claim, demand, action or right of action, of whatever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death or property damage resulting or to result from any accident that may occur as a result of my or my child’s participation in the camp activities or any activities in connection with the Longbranch Community Baptist ChurchKids Life Xxxx (TEBA)/Carolina Creek Christian Camp, whether or caused in whole or in part by the negli- gence (but not gross negligence or notrecklessness) of Kids Life Xxxx (TEBA) /Carolina Creek Christian Camp, its officers, agents, employees or participants. Miscellaneous Provisions I, personally, and on behalf of my child (if child is the camp participant), hereby give Longbranch Community Baptist Church Kids Life Xxxx (TEBA)/ Carolina Creek Christian Camp permission to use my and/or my child’s name, photograph, quotations and likeness in any advertisements or promotions performed in connection with the camp and agree that neither I nor my child shall be entitled to any compensation for such use. I agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that if any portion of this agreement is held invalid, it is agreed that the balance shall, notwithstandingnot withstanding, continue in full legal force and effect. Kids Life Xxxx (TEBA)/Carolina Creek Christian Camp is authorized to provide or obtain medical care for me or the child, as it deems appropriate, and to exchange medical information with third party care givers. To the extent a claim asserted against a Released Party by a camper or other visitor or Parent shall be brought exclusively in Xxxxxx County, Texas, and the laws applicable thereto shall be those of the State of Texas, not including those laws which may apply the laws of another jurisdiction. This Agreement may be amended only by a written instrument, signed by the parties hereto. STUDENT OR SPONSOR T-SHIRT SIZE YM AS YL AM AL AXL A2XL A3XL This Agreement is intended to be binding upon my, and the child’s, heirs, estates, executors, guardians, administrators, legal representatives and assigns. X Date: X Adult Participant or Parent/Guardian Signature Printed Name and Address of Signatory:: Authorization for Emergency Medical Treatment General Release and Waiver of Liability

Authorization for Emergency. Medical Treatment I have listed above my or my/my child’s physical conditions or medical problems that may need attention and all medications regularly used by myself or said minor. I understand failure to disclose medical information/condition may result in dismissal from Longbranch Community Baptist ChurchKids Life Xxxx and Carolina Creek Christian Camp. In case of the illness of myself or my child, Longbranch Community Baptist Church Kids Life Xxxx and Carolina Creek Christian Camp will try to notify whoever is listed as the emergency contact person. In the event there arises of a medical emergency concerning myself or my child, at a time where the emergency contact cannot be notified, I authorize Longbranch Community Baptist Church Kids Life Xxxx and Carolina Creek Christian Camp to consent to any necessary X-ray examination, anesthetic, medical or surgical diagnosis or and/or treatment, or hospital care. I hereby consent and give my permission consent to the Longbranch Community Baptist Church Kids Life Xxxx and Carolina Creek Christian Camp staff or any attending physician the authority to make such decisions and to perform such medical treatments and/or surgery upon myself or my child that may, in their sole discretion, be deemed necessary and proper under the circumstances. General Release and Waiver of Liability I DO RELEASE, ACQUIT, DISCHARGE, AND COVENANT COMMIT TO HOLD HARMLESS Longbranch Community Baptist Church THE TEBA KIDS LIFE XXXX AND CAROLINA CREEK CHRISTIAN CAMP STAFF, PERSONNEL, OR ANY OF ITS REPRESENTATIVES FROM ANY ACTIONS, DAMAGES, OR LIABILITIES ARISING OUT OF ANY INJURIES OR PROPERTY DAMAGE SUSTAINED DURING THE PARTICIPATION IN THE CAMP AND/OR RESULTING FROM THE TREATMENT OF ANY ILLNESS, SICKNESS, OR ACCIDENT, INCURRED BY MYSELF OR MY CHILD DURING HIS/HER STAY AT Longbranch Community Baptist ChurchKIDS LIFE XXXX AND CAROLINA CREEK CHRISTIAN CAMP. In consideration for being permitted to attend Longbranch Community Baptist Church Kids Life Xxxx and Carolina Creek Christian Camp and participate in the activities conducted by the Camp, I, on behalf of myself, my child, my legal representatives, heirs and assigns, do hereby release, waive, and forever discharge Longbranch Community the Xxxxx Evergreen Baptist Church Association Kids Life Xxxx and Carolina Creek Christian Camp and its officers, employees, volunteers, and agents, of and from any and all loss, damage, claim, demand, action or right of action, of whatever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death or property damage resulting or to result from any accident that may occur as a result of my or my child’s participation in the camp activities or any activities in connection with the Longbranch Community Baptist ChurchTEBA Kids Life Xxxx and Carolina Creek Christian Camp, whether by negligence or not. I, personally, and or on behalf of my child (if child is the camp participantparticipant is a minor), hereby give Longbranch Community Baptist Church the TEBA Kids Life Xxxx and Carolina Creek Christian Camp permission to use my and/or my child’s name, photograph, quotations quotes and likeness in any advertisements or promotions performed in connection with the camp and agree that neither I nor my child shall be entitled to any compensation for such use. STUDENT OR SPONSOR T-SHIRT SIZE YM AS YL AM AL AXL A2XL A3XL I agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that if any portion of this agreement is held determined to be invalid, it is understood and agreed that the balance shall, notwithstanding, continue in full legal force and effect. X Adult Participant or Parent/Guardian Signature Printed Name and Address of Signatory:: X

Authorization for Emergency. Medical Treatment I have listed above my or my child’s physical conditions or medical problems that may need attention and all medications regularly used by myself or said minor. I understand failure to disclose medical information/condition may result in dismissal from Longbranch Community Baptist ChurchCarolina Creek Christian Camp. In case of the illness of myself or my child, Longbranch Community Baptist Church Carolina Creek Christian Camp will try to notify whoever is listed as the emergency contact person. In the event there arises a medical emergency concerning myself or my child, at a time where the emergency contact cannot be notified, I authorize Longbranch Community Baptist Church Carolina Creek Christian Camp to consent to any necessary X-ray examination, anesthetic, medical or surgical diagnosis or treatment, or hospital care. I hereby consent and give my permission to the Longbranch Community Baptist Church Carolina Creek Christian Camp staff or any attending physician to make such decisions and to perform such medical treatments and/or surgery upon myself or my child that may, in their sole discretion, be necessary and proper under the circumstances. General Release and Waiver of Liability I DO RELEASE, ACQUIT, DISCHARGE, AND COVENANT TO HOLD HARMLESS Longbranch Community Baptist Church CAROLINA CREEK CHRISTIAN CAMP STAFF, PERSONNEL, OR ANY OF ITS REPRESENTATIVES FROM ANY ACTIONS, DAMAGES, OR LIABILITIES ARISING OUT OF ANY INJURIES OR PROPERTY DAMAGE SUSTAINED DURING THE PARTICIPATION IN THE CAMP AND/OR RESULTING FROM THE TREATMENT OF ANY ILLNESS, SICKNESS, OR ACCIDENT, INCURRED BY MYSELF OR MY CHILD DURING HIS/HER STAY AT Longbranch Community Baptist ChurchCAROLINA CREEK CHRISTIAN CAMP, EVEN IF SUCH INJURIES OR DAMAGES ARE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE (BUT NOT GROSS NEGLIGENCE OR RECKLESSNESS) OF CAROLINA CREEK CHRISTIAN CAMP, ITS OFFICERS, AGENTS, EMPLOYEES OR PARTICIPANTS. In consideration for being permitted to attend Longbranch Community Baptist Church Carolina Creek Christian Camp and participate in the activities conducted by the Camp, I, on behalf of myself, my child, my legal representatives, heirs and assigns, do hereby release, waive, and forever discharge Longbranch Community Baptist Church Carolina Creek Christian Camp and its officers, employees, volunteers, and agents, of and from any and all loss, damage, claim, demand, action or right of action, of whatever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death or property damage resulting or to result from any accident that may occur as a result of my or my child’s participation in the camp activities or any activities in connection with the Longbranch Community Baptist ChurchCarolina Creek Christian Camp, whether or caused in whole or in part by the negligence (but not gross negligence or notrecklessness) of Carolina Creek Christian Camp, its officers, agents, employees or participants. Miscellaneous Provisions I, personally, and on behalf of my child (if child is the camp participant), hereby give Longbranch Community Baptist Church Carolina Creek Christian Camp permission to use my and/or my child’s name, photograph, quotations and likeness in any advertisements or promotions performed in connection with the camp and agree that neither I nor my child shall be entitled to any compensation for such use. I agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that if any portion of this agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Carolina Creek Christian Camp is authorized to provide or obtain medical care for me or the child, as it deems appropriate, and to exchange medical information with third party care givers. To the extent a claim asserted against a Released Party by a camper or other visitor or Parent shall be brought exclusively in Walker County, Texas, and the laws applicable thereto shall be those of the State of Texas, not including those laws which may apply the laws of another jurisdiction. This Agreement may be amended only by a written instrument, signed by the parties hereto. This Agreement is intended to be binding upon my, and the child’s, heirs, estates, executors, guardians, administrators, legal representatives and assigns. X Adult Participant or Parent/Guardian Signature Printed Name and Address of Signatory: