Medical Release & Permission Form (Page 2 of 2) in pdf

Medical Release & Permission Form Page 2

2015-2016

Medical Release & Permission Form

Page 2 of 2

has my permission to attend all youth activities

AME OF

OUTH

sponsored by Manchaca United Methodist Church (hereinafter the “Church”) from today until September 30, 2016.

This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the

Church and its staff from any liability against personal losses of above-named youth.

I/We the undersigned have legal custody of the above-named youth, a minor, and have given my/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 youth’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 above-named youth. I/we also

agree to bring my/our youth home at my/our own expense should they become ill or if deemed necessary by the youth

ministries staff member.

Parent/guardian signature: ________________________________________________ Date: __________________

Medical Release & Permission Form Page 2