First, tell us about yourself:

Parent Information

By checking the box you will be emailed your digital Friends With God Kids Activity Pack.

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Tell us about your participant:

Media Permission

Do you give permission to the Presbyterian Church of Novato (PCN) to use video and photographic images of your child participating in the PCN youth programs?  Any such images will become the property of PCN and can be used without compensation.  No child will be identified by name or location.  Select *ONEof the checkboxes below.

Liability Release

In consideration for being accepted by Presbyterian Church of Novato (PCN) for participation in any event administratively organized by PCN or any of its officers, directors, employees, and agents, through May 31, 2019, we (I), being 18 years of age or older, do for ourselves (myself) [and for and on behalf of my child-participant if said child is not 18 years of age or older] do hereby release, forever discharge and agree to hold harmless PCN and its officers, directors, employees, and agents from any and all manner of suit, sickness or death, as well as property damage and expenses, of any nature whatsoever, which may be incurred by the undersigned and the child-participant while the said child-participant is participating in any event administratively organized by PCN or any of its officers, directors, employees, and agents. 

The undersigned further hereby agree to hold harmless and indemnify PCN, its officers, directors, employees, and agents, for any liability sustained by PCN as a result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant there to. 

We (I) understand that the document constitutes a full and complete waiver of all possible claims, including, but in no way limited to, claims for negligence in personal or property damages arising out of said participant’s involvement in any event administratively organized by PCN or any of its officers, directors, employees, and agents.   No provision of this document shall, in any way, limit my right to make claims against persons other than PCN, its officers, employees and agents.  [If the participant has not attained the age of 18 years]: 

We (I) are the parents(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him/her to participate fully in said trip/activity, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any. We (I) understand that a conscientious effort must be made to notify one of the parents or legal guardians listed below before such action is taken.   

This authorization is given pursuant to the provisions of § 25.8 of the Civil Code of California. 

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