Permission/medical Release Form (Page 2 of 2) in pdf

Permission/medical Release Form Page 2

Permission for Minors: I hereby give permission for my child ______________________________ to attend

the above events and participate fully in the included activities.

Emergency Medical Care: In the event that ___________________________ (person attending event) suffers

any illness or accident requiring emergency hospitalization while at this United Methodist Church event, I

hereby give permission for any necessary hospitalization. I hereby give permission to the physician selected to

order x-rays, routine tests, and treatment for the health of the above named. I realize that every effort will be

made to contact me and/or the contact person above in case of emergency. In the event that I may not be able to

be reached in an emergency, I hereby give permission to a physician to hospitalize/secure treatment for/order

injection or anesthesia for the above named. I will not hold Summerfield United Methodist Church responsible

in the event of accident, loss, or death.

_________________________________________________________

If this form is for adult participant at the event, please sign here.

If for a youth under the age of 18, parent/guardian must sign here.

Permission/medical Release Form Page 2