Participant's Information
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Please list all participating individuals, oldest to youngest, and include birthdays for each.
Medical Concerns & Allergies
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Please list any medical concerns or allergies for each participant.
Signature
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I understand all reasonable safety precautions will be taken by SHALOM MACON and its agents during events, trips, and activities. I also understand the possibility of unforeseen hazards and know the inherent possibility of risk. I hereby agree to release and forever discharge, and agree to hold harmless, SHALOM MACON, its leaders, employees, volunteer staff from any liability, and claims for damages, losses, sickness, or injuries. I understand that if medical attention is needed, for this individual during this activity, every attempt will be made to consult the listed contact person on this form. If, however, the persons listed cannot be reached, I give my permission to the activity leaders to secure the services of a licensed physician or surgeon to provide medical services deemed necessary for the well-being of the individual.
