Medical Release Form (Page 2 of 2) in pdf

Medical Release Form Page 2

I/We the undersigned have legal custody of the student named above, a minor, and have given our

consent for him/her to attend events being organized by the Church. I/We understand that there are

inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors,

employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to

person or property that may occur during the course of my/our child’s involvement. In the event that

he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment

as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or

hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any

claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge

that we will be ultimately responsible for the cost of any medical care should the cost of that medical care

not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance

information provided above is accurate at this date and will, to the best of my/our knowledge, still be in

force for the student named above. I/we also agree to bring my/our child home at my/our own expense

should they become ill or if deemed necessary by the student ministries staff member.

Parent/Legal Guardian Signature:________________________________Date_______________

**IF NEEDED, MAY WE ADMINISTER TYLENOL OR IBUPROFEN TO YOUR

TEEN? ______________

Medical Release Form Page 2