Forged Tubing at Kelly Park


Event Name: Tubing at Rock Springs (Kelly Park)

Date: Thursday, June 6, 2019 (7 a.m. to 5 p.m.)

Location: One More Child 1015 Sikes Blvd., Lakeland, FL 33815

Details: Cool down with Forged Youth at the crystal, clear springs of Kelly Park! Cost is $5 and covers
entrance fee, gas for bus, and tolls. Tube rental is an additional $5-7. Please bring a towel,
sunblock, change of clothes, a lunch and any snacks you might want. We will bring a cooler(s)
with ice and water. If you prefer, you can bring money for lunch at the park’s concession
stand.

SINCE THE PARK FILLS QUICKLY AND SINCE ENTRANCE CLOSES ONCE IT REACHES CAPACITY, WE
NEED TO ARRIVE EARLY. PLEASE BE AT PCH AND READY TO SCOOT NO LATER THAN 7 A.M.

Water shoes and bug spray are strongly suggested.



I have completed a Medical Information and On-Site Release Form (updated for 2019) and have filed this with the church office.

CONSENT: I am the participant or parent and legal guardian of the minor child named below.  I hereby give permission for my child to attend the Tubing at Rock Springs/Kelly Park outing and authorize Presbyterian Church in the Highlands, Inc. (“PCH”) to furnish necessary transportation to and from Kelly Park in Apopka, FL. I understand that transportation may be provided via vehicles owned and operated by PCH or by vehicles owned and operated by adult volunteers for PCH.

RELEASE: In consideration of me/my child being able to participate in the above described activity, I hereby release and agree to hold harmless PCH and its officers, directors, employees, administrators, and agents, including, without limitation, any PCH volunteers, from any and all liability, claims, causes of action, damages and demands whatsoever, including without limitation, any and all claims or causes of action for personal injury, sickness, or death which may be incurred by me/my child resulting from my/my child’s participation in above described activity, including, without limitation, transportation to and from the excursion.

EMERGENCY AUTHORIZATION: I hereby authorize and appoint Jared Edgar and/or other adult leaders of PCH in whose care me/my minor child has been entrusted, to arrange for and consent to any emergency or ordinary and necessary medical care or treatment, for me/my said child as a result of any accident or illness in the event I cannot be located or contacted by the medical treatment provider. I understand and agree that I shall be liable for all costs and expenses incurred in connection with such medical care or treatment rendered to me/my said child pursuant to this authorization.

DISCIPLINE: I agree that if the subject of this release has to return home for severe discipline violations, it will be at my/our expense.

PHOTO AND VIDEO: I/We consent to the use of any video images or photographs (digital or conventional) that may be taken of the subject of this release during the event to be used for video recaps, in social media, or other appropriate media as PCH sees fit.


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Signature Certificate
Document name: Forged Tubing at Kelly Park
Unique Document ID: 9501b8b6108a60ba9ab55fd6db4355e8400f8e2e
Timestamp Audit
May 28, 2019 3:50 pm EDTForged Tubing at Kelly Park Uploaded by Jared Edgar - youth@pchighlands.com IP 47.205.109.177