HOUSEHOLD MEDICAL RELEASE FORM AND INDEMNITY AGREEMENT Sept 1, 2024- Aug 31, 2025

Parents/Legal Guardians agreement of release and indemnity. Read this Agreement carefully. It must be signed (clicking yes or no to all statments, typing full name of parent/legal guardian and clicking "submit" form) by the Parent/Legal Guardian of the minor. Agreement is good 9/1/2024 through 8/31/2025.

By selecting "YES" using any device, means, or action, I consent to the legally binding terms and conditions of this document.

For the purpose of this form, the child listed on this form is hereinafter Minor and Cowboy Fellowship of Atascosa County, Inc. is hereinafter Cowboy Fellowship.

Full Name of Minor

DOB (MM/DD/YYYY)

Gender

Male Female

List all known allergies (Including food and & medication):

List existing medical conditions/medications cowboy Fellowship should be aware of:

I understand that my child will be allowed to take in-town and out-of-town trips with Cowboy Fellowship. I agree that the staff members, adult leaders and volunteers, and Cowboy Fellowship shall not be held responsible for any accident or misfortune, which might occur in connection with these activities. You may also be assured that he/she is being permitted to make these trips with my consent.

I further give full authority to the adult leader(s) to discipline Minor as the adult leader(s) deem necessary. If the minor’s behavior is such that it endangers the happiness or safety of the entire group, then the adult leader(s) has my permission to send Minor home after notifying me of his/her intention to do so. I further promise to pay the cost of Minor’s return trip home if this action becomes necessary. In consideration of the foregoing, as well as the supervision provided on my behalf and on the behalf of Minor, I hereby hold the adult leader(s) and/or Cowboy Fellowship harmless for the results of any decisions he/she in his/her discretion shall make.

As is authorized in Section 32.001 of the Family Code of the State of Texas entitled “Consent by Non-Parent,” in the event on an accident or illness concerning Minor, Cowboy Fellowship acting by and through its adult representatives will use its best effort to contact the parent(s) or legal guardian of Minor as soon as is reasonably possible. In the event the parent(s) or legal guardian is not available, a minister of Cowboy Fellowship, a staff member of Cowboy Fellowship, or other adult leader, as adults who have the actual care, control, and possession of Minor are authorized by this written document to secure and consent to such medical, dental, psychological, and/or surgical treatment for Minor as they in their sole discretion shall deem necessary for the treatment of the accident or illness.

I, the undersigned parent or legal guardian, assume full responsibility for all medical bills, doctor bills, and/or hospital bills or otherwise incurred by Minor. Further I agree to indemnify and reimburse Cowboy Fellowship, and/or any other agents, employees, adult leaders, volunteers, or otherwise of Cowboy Fellowship who shall incur such expenses in the treatment of the accident or illness of Minor the full amount which shall be expended.

I further agree that my typed signature (full legal name) is as valid as if I signed the document in writing. After clicking "submit", I will receive confirmation this document has been submitted and is on file.

I certify that the information given on this form is correct and have read and understand this agreement. I also understand that it is my responsibility to inform Cowboy Fellowship of any changes that should occur during the duration this form will be utilized as indicated above.

Full Legal Name of Parent/Legal Guardian. Typing in full legal name represents full consent and understanding of this agreement.

Relation to Minor

Address

Phone

This address will receive a confirmation email

Full Legal Name of Parent/Guardian #2. Typing in full legal name represents full consent and understanding of this agreement.

Relation to Minor

Phone

HOUSEHOLD MEDICAL RELEASE FORM AND INDEMNITY AGREEMENT Sept 1, 2024- Aug 31, 2025

Description

Please Fix the Following