Children's Form

My child may be given acetaminophen, ibuprofen, or antihistamine by the leaders as needed. I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I cannot be reached in an emergency, I hereby give my permission to the qualified and licensed physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary.
I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed. Coverage by the Presbyterian Church of Barrington (PCB) through its accident policy will be used as a backup for what my family’s insurance does not cover. Limited coverage of excess medical expenses is available to the maximum allowed per the church’s insurance policy.
I understand all reasonable safety precautions will be taken at all times by PCB and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold PCB, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by my child.