I agree to indemnify and hold Marysville Church of the Nazarene, the Northwestern Ohio District Church of the Nazarene, the General Church of the Nazarene, or any of their agencies, departments, officers, employees, members or agents from all damages, judgments, expenses, attorney's fees and claims arising out of personal injury, death, or property damage sustained in whole or in part by any or all persons whatsoever as a result of or arising out of any act or omission of guest group or attendee, or caused by or resulting from any activity or program being conducted by guest group or use of Marysville Church of the Nazarene facilities, or cancellation/closure due to natural disaster and/or emergency.
I understand that Marysville Church of the Nazarene carries medical and hospitalization insurance coverage which, consistent with the exclusions, limitations, and terms thereof may provide benefits over and above any personal medical and hospitalization coverage available to my family. I understand that any personal medical and/or hospitalization insurance available to my family will provide primary coverage and the ministry's medical and hospitalization coverage (subject to the exclusions, limitations, and provisions in the ministry's policy) may provide secondary or excess coverage. I agree to apply first for benefits from the personal medical and/or hospitalization coverage available to my family, if any, before applying for benefits that may be available from the ministry's medical and hospitalization coverage.
I further understand that, in the event my child requires medical or dental treatment while engaged in any activity, reasonable efforts will be made to contact me; however, if I cannot be reached, I hereby consent and give permission to the ministry's youth pastor or any adult volunteer acting on behalf of the ministry with respect to the activity, as agenet for me, to consent to any X-ray examination, injections, anesthesia, medial, dental, or surgical diagnosis and treatment, and hospital care and treatment advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either as an outpatient or in any hospital. To the best of my knowledge, I have listed above all of my child's medical allergies, medications being taken, medical problems, and other pertinent information. My child has permission to participate in all prescribed activities except as noted by me.
**If any information on this form changes, it is the responsibility of the parent or guardian to notify the Youth Pastor prior to the activity/trip.
PHOTO RELEASE AUTHORIZATION: Marysville Church of the Nazarene (MaryNaz) occasionally uses video and photographs of children/students for promotional purposes.
As the parent or legal guardian of the child whose online form I am submitting, a minor, I grant permission to Marysville Church of the Nazarene to record on film, video tape, or audio tape his or her participation in Marysville Nazarene events. I further agree that any or all of the material recorded may be used in any form, as part of any future production(s) made by or for the promotion of Marysville Nazarene; and further that such use shall be without payment of fees, royalties, special credit, or other compensation.
I understand I may opt out of this photo release by sending an email to marynaz@marysvillenazarene.org stating my wishes, along with the name(s) of my child(ren).
By signing my name, I agree to the terms in the agreement above: