Medical Release Form

ADVERTISEMENT

MEDICAL RELEASE FORM
(Release of all Claims)
While accompanying Mundelein Church of the Nazarene to:
______________________________________ (trip/activity) on ___________ (date)
I authorize __________________________________________ (name of minor child)
to receive medical and/or dental care in the event of a medical emergency/illness.
I
understand that abovementioned child will receive on-site first aid, however if additional aid
is deemed necessary by any chaperone appointed by the church, transportation to the nearest
medical facility will occur.
Signature ____________________________________ (parent/guardian of minor child)
Home Telephone Number ______________ Work/Cell Telephone Number ______________
Insurance Company/Telephone Number __________________________________________
Policy Number ________________ Responsible Party/SSN __________________________
Please list any known allergies or medical conditions:
----------------------------------------------------------------------------------------------------------------
LIABILITY RELEASE FORM
(Release of all Claims)
While accompanying Mundelein Church of the Nazarene to:
______________________________________ (trip/activity) on ___________ (date)
I do hereby release, forever discharge, and agree to hold harmless the church and the
directors thereof from any and all liability, claims or demands for personal injury, sickness or
death, as well as property damage and expenses of any nature which may be incurred by the
undersigned/ participant occurring while said person is participating in the above-described
trip or activity. The undersigned further hereby agrees to hold harmless and indemnify said
Church, its directors, employees and agents for any liability sustained by said acts of said
participant, including expenses incurred attendant thereto.
Signed this _____ day of _________, 2008
Participant Signature _______________________________ (parent/guardian if minor child)
Participant Name __________________________________

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go