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Parent Information

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CONSENT AND CERTIFICATION

I/we, being the parent or legal guardian of the child named above (the "child"), do hereby consent to the participation of our child in the activities of His House Ministries/Armenian Language Arts at Destiny Christian Church (Sacramento Campus), located at 9470 Micron Avenue, Sacramento, CA 95827 on 08/31/2024 – 05/17/2025 (916) 384-8374.

ON-CAMPUS ACTIVITIES including, but not limited to: The purpose of this program is educational. Children will learn how to read, write, and communicate in Armenian. There will be a 30-minute recess time in the Activity Center. During one of the most hectic times of the day, our team provides organized games (Ball Activities, Hula Hoop Activities, Jump Rope Activities, Long Jump Rope, etc.) and activities in the schoolyard.

OFF-CAMPUS ACTIVITIES: Taking our students to the zoo.

I/we hereby represent that the child is in good health and in proper physical condition to participate in the above activities. Further, I/we certify that our child is physically able and adequately trained to participate in such events, including swimming. I/we understand and acknowledge the physical rigors associated with the activities and understand that participation involves risks and dangers which include, without limitation, the potential for serious bodily injury, permanent disability, paralysis, and death; accidents in the use of firearms; inaccessibility of medical care; dangers arising from adverse weather conditions; inadequate safety measures; participants of varying skill levels; situations beyond the immediate control of DCC(SC); and other undefined harm or damage which may not be readily foreseeable, and other presently unknown risks and dangers ("Risks"). I/we understand that these Risks may be caused in whole or in part by child’s own actions or inactions, the actions or inactions of others participating in the activity, and I/we hereby expressly authorize my child to participate in the above activities.

List any activities you DO NOT AUTHORIZE your child to participate in:

MEDICAL QUESTIONNAIRE

Is your child presently being treated for an injury or sickness?

Is your child presently taking any form of medication?

Is your child allergic to any type of medication?

Does your child require a special diet?

Does your child have any allergies other than medical?

Does your child have any physical condition or illness which would prevent him/her from participating in normal rigorous activity?

Can your child swim?

Does your child ever sleep walk?

Does your child currently have or previously had any of the following:

MEDICAL TREATMENT AUTHORIZATION

Terms

I /we understand that I/we will be notified in the case of a medical emergency involving our child. However, in the event that I/we, cannot be reached, I/we authorize the calling of a doctor and the providing of necessary medical services in the event that our child is injured or becomes ill. I/we authorize any one or more of the following persons to make emergency medical care decisions on behalf of our child if required by law or a health care provider:

I/we understand that DCC (SC), or any of their agents, employees, or volunteers, will not be responsible for medical expenses incurred on the basis of this authorization.

I/we agree to notify DCC (SC) in the event of any health changes which would restrict our child's participation in any activities. I/we also understand that the adult church/school representatives reserve the right to restrict our child from any activity that they do not feel is within the physical capabilities of my child.

Signature of Parents/Guardians:

I have read and agree to the terms above.

Date Field

I/we authorize any one or more of the following persons to make emergency medical care decisions:

Emergency contact person

Phone Number

Emergency contact person

Phone Number

GENERAL RELEASE AND ASSUMPTION OF RISK

Terms

KNOWING THE RISKS DESCRIBED ABOVE, I / WE AGREE, ON BEHALF OF OURSELVES AND OUR CHILD, FAMILY, HEIRS, AND PERSONAL REPRESENTATIVES, TO ASSUME ALL THE RISKS AND RESPONSIBILITIES SURROUNDING OUR CHILD’S PARTICIPATION IN THE ABOVE-DESCRIBED ACTIVITIES, BOTH KNOWN AND UNKNOWN. TO THE MAXIMUM EXTENT ALLOWED BY LAW, I / WE RELEASE, HOLD HARMLESS, AND AGREE TO INDEMNIFY DESTINY CHRISTIAN CHURCH (SACRAMENTO CAMPUS), AND ITS AFFILIATED MINISTRIES AND THEIR OFFICERS, DIRECTORS, EMPLOYEES, VOLUNTEERS, AND AGENTS, FROM AND AGAINST ANY PRESENT OR FUTURE CLAIMS, LOSSES, LIABILITIES, COSTS AND EXPENSES FOR INJURY TO PERSON OR PROPERTY, OR FOR ANY OTHER DAMAGE, WHICH OUR CHILD MAY SUFFER, OR FOR WHICH OUR CHILD MAY BE LIABLE TO ANY OTHER PERSON, RELATED TO OUR CHILD’S PARTICIPATING IN SAID ACTIVITIES (INCLUDING PERIODS IN TRANSIT TO OR FROM DESTINATIONS), RESULTING FROM ANY CAUSE, INCLUDING BUT NOT LIMITED TO NEGLIGENCE ON OUR CHILD’S PART OR ON THE PART OF ANY OF THE RELEASED PARTIES; PROVIDED THAT THIS RELEASE OF LIABILITY SHALL NOT APPLY TO GROSS NEGLIGENCE OR WILLFUL OR WANTON MISCONDUCT.

1. I/We expressly waive any defense to the enforcement of any provision of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal, valid, and binding obligation upon me/us enforceable against me/us in accordance with its terms.

Invalidation of any one or more of the provisions of this Agreement shall in no way affect any of the other provisions hereof, which shall remain in full force and effect.

2. I/We expressly agree that this assumption of risk, release, and indemnity agreement is intended to be as broad and inclusive as permitted by law. I/We further state that I/WE HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND ITS CONTENTS, AND I/WE VOLUNTARILY SIGN THIS AGREEMENT AS MY/OUR OWN FREE ACT.

I/We understand and agree that no oral or written representations can or will alter the contents of this document. This Agreement shall be governed and construed in accordance with the laws of the State of California, excluding its choice of law rules, and all claims relating to or arising out of this Agreement, including claims for injuries or wrongful death in any way related to the above-described activities, shall likewise be governed by the laws of the State of California, excluding its choice of law rules.

I/we attest to the truthfulness, accuracy, and validity of the foregoing statements.

Signature of Parent / Guardian:

I, the undersigned, agree to the terms above.

Minor Child’s Name:

Date Field

Registration Fee

$40.00

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Your current total for 1 registrant is $43.14 (Show Summary)

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