I grant the above participant permission to go on and participate in the stated activities: REAL GIRLS during the 1st or 2nd Tuesday of every month from September 2016 - May2017. In consideration of the above participant being permitted to participate in such an activity, I hereby release, forever discharge and agree to hold harmless First Baptist Lavaca and any and all directors thereof from any and all liability, claims or demands and expenses of any nature whatsoever which may be incurred by the undersigned and the participant. I also grant permission to First Baptist Lavaca to utilize the participant’s image or likeness incidental to any live or recorded video display, photography or other transmission or reproduction, in whole or in part, of the activity to which this form admits him or her.
We (I) do hereby grant permission of First Lavaca staff or volunteers to take said participant to a physician or hospital, and hereby authorized medical treatment including but not in limitation to any x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical services rendered to our (my) participant pursuant to this authorization.