As a parent or guardian of the minor listed below, I hereby authorize my child to participate in the following activity organized by the Lighthouse Student Ministry of Healing Waters Worship Center.

I hereby release and discharge Healing Waters Worship Center, ministry leaders and volunteers for any damages, losses, or injuries to person or property that may be sustained while participating in these activities. I, the undersigned parent or legal guardian of the minor named below, authorize treatment and/or hospitalization that is necessary in the case of an accident or illness of my child by a licensed medical physician. However, every attempt will be made to reach me by telephone prior to any treatment. In the event that I cannot be reached in an emergency, I hereby give my permission to the licensed medical physician or dentist selected by the church leader to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary.  

By initialing below I am recognizing it as my electronic signature.

In the event that I can not be reached, please notify: