Student Registration

I, the undersigned, parent of the below listed child, a minor, do hereby authorize the Camp Freedom staff, as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgery diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician and surgeon licensed under the provision of the Medical Practice Act, whether such a diagnosis or treatment is rendered at the office of said physician or at a hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment, and or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable.

I agree to indemnify, defend, and hold harmless Camp Freedom Staff, Pfrimmer’s Chapel Church Inc., O’Bannon Woods State Park, and each of their respective agents, employees, officers, volunteers, directors, and representatives from and against any and all claims, liabilities, damages, losses, costs (including court costs and discovery expenses), and attorney’s fees arising out of or related to my child’s use of, or presence on, any real or personal property owned, leased, or controlled by Pfrimmer’s Chapel Church Inc., O’Bannon Woods State Park, or their affiliates. This includes, but is not limited to, claims arising from any act, omission, or negligence of my child. I also release media liability and give the same aforementioned individuals and entities permission to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital and printed media.