Dodgeball Youth Permission Form

First Presbyterian Church, Kerrville
800 Jefferson Street
Kerrville, TX 78028
830-257-3310

Youth Name(Required)
Address(Required)
Emergency Contact(Required)
Terms of Service(Required)

In consideration of, Youth Named above, being permitted to participate in a Youth Dodgeball Tournament on the campus of First Presbyterian Church Kerrville, I, Parent Named below, in full recognition and appreciation of any risks inherent in such activities, do hereby waive, release, and forever discharge First Presbyterian Church Kerrville, its employees, and agents from and against any and all claims, demands, action or causes of action for costs, expense or damages to personal property or personal injury, which may result from my participation in these activities on all parts of the church campus.

I assume full responsibility for any injuries or damages resulting from my participation in a Youth Dodgeball Tournament on Sunday, February 19, 2023 including responsibility for using reasonable judgment in all phases of participation in this program being held on the campus of First Presbyterian Church Kerrville. I also understand that this Waiver of Liability and Release binds my heirs, executors, administrators, and assigns as well as myself.

In the event of an emergency requiring medical attention for my child, I understand that every effort will be made to contact me first. However, if I cannot be reached, I authorize the adult leaders of the activity to administer first-aid as necessary and/or to transport my child to the hospital and to secure appropriate medical care on my behalf, including consent to any x-ray examination, medical, dental, or surgical diagnosis, and hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice in Texas. The costs resulting from accidents to children are born by the parent’s health insurer.

Parent Name(Required)
Date(Required)
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