Statement of Consent

*THIS CONSENT FORM IS A REQUIREMENT FOR ALL DEPENDANTS (ANYONE UNDER THE AGE OF 18)*

I GIVE PERMISSION FOR INFINITY CHURCH STAFF AND VOLUNTEERS TO OBTAIN EMERGENCY MEDICAL, HOSPITAL OR AMBULANCE SERVICE AT ANYTIME THEY CONSIDER NECESSARY. I UNDERSTAND THAT EVERY EFFORT WILL BE MADE FOR ME TO BE NOTIFIED BEFORE INSTITUTING SUCH PROCEDURES. I ACKNOWLEDGE THAT I WILL BE LIABLE FOR ANY MEDICAL, HOSPITAL OR AMBULANCE EXPENSES INCURRED IN THE TREATMENT FOR MY CHILD. I ALSO UNDERSTAND THAT WHILE EVERY PRECAUTION WILL BE TAKEN TO ENSURE THE PROTECTION OF MY CHILD, INFINITY CHURCH, INFINITY YOUTH (IY) STAFF AND VOLUNTEERS ARE RELEASED FROM ANY AND ALL LIABILITY IN THE EVENT OF ANY ACCIDENT OR MISFORTUNE, DAMAGE OR LOSS THAT MAY OCCUR TO THE CHILD OR PROPERTY.