ACTIVITY WAIVER The undersigned participant hereby gives permission to Trinity Presbyterian Church for (name) ________________________________________ to take part in the following activity: __________________________________________. Should my I require immediate or emergency medical care while engaged in an activity sponsored by the Church, in my absence, I hereby grant the Church authority to release my information for medical treatment to such medical personnel as the Church determines appropriate under the circumstances. Furthermore, I release Trinity Presbyterian Church, its officers, and agents from any liability which may arise from the giving of such authorization, it being my desire that I be furnished with such medical or surgical services as soon as possible after the need arises. In consideration for the privilege of allowing myself to participate in the above-named activity, I agree to release and hold harmless the Church, its officers, and agents from any liability to or responsibility for bodily injury, damage, or illness to the above-identified participant while participating in any athletic or social activity which may be directly or indirectly sponsored by the Church. Further, I agree to indemnify and hold harmless the Church, its officers, and agents with respect to any claim asserted by or on my behalf as a result of bodily injury, illness, or damage. PLEASE READ CAREFULLY. THIS IS A LEGAL DOCUMENT WHICH INCLUDES A RELEASE OF LIABILITY AND INDEMNIFICATION. ____________________ ________________________________________________ Date Signature of Participant Telephone numbers: Cell __________________________ Other ________________________ List any special instructions, medical conditions, allergies: Health/accident insurance covering the participant (company, numbers):