Any medications, special needs, allergies, etc.
RELEASE OF LIABILITY In consideration of the receipt and evaluation of this application by First MB, I hereby release First MB and its representatives, as well as any outside individual, group, agency, or organization, from and and all liability for damages of whatever kind or nature, including claims for breach of privacy, that may at any time result to me, or anyone entitled to recover through me or because of their relationship to me, in connection with the preceding Authorization. Further, in consideration of First MB allowing me to participate in Dare 2 Share Live, I, for myself as well as for anyone entitled to recover through me or because of their relationship to me, hereby waive and release all right and claim for damage that may exist against First MB and its agents, employees, representatives, volunteers, successors and assigns (collectively, "the Released Parties"), for any and all injuries or damages of any sort suffered buy me arising out of my participation. I further agree that in the event any party or entity makes any claim against the Released Parties for injuries or damages arising out of such participation, I will indemnify, defend, and hold the Released Parties harmless, from any and all damages and expenses occasioned thereby including attorney's fees. MEDICAL RELEASE OF LIABILITY Consent To Treatment of a Minor: As Parent/Guardian of the named participant, I here be authorize a duly authorized representative of First Mennonite Brethren Church to secure any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any hospital; or to consent to any x-ray examination, anesthetic, dental or surgical diagnosis or treatment to be rendered by any licensed dentist in which dental care is being sought. I HAVE CAREFULLY READ AND UNDERSTAND THE CONTENTS OF THESE 'ACKNOWLEDGEMENTS AND AGREEMENTS' AND SIGN THIS DOCUMENT AS MY OWN ACT, RECOGNIZING THAT IT IS LEGALLY BINDING.