Medical Release and Authorization
Information received is confidential and is being gathered for the purpose of serving your child while in the care of CALVARY PENTECOSTAL TABERNACLE. Any medical information collected here serves to authorize Calvary Pentecostal Tabernacle, and its staff and volunteers, to obtain medical assistance in emergencies. This form is to be completed by the parent or guardian of the child.
Calvary Pentecostal Tabernacle is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the child to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our organization. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel.
In the event of an accident, illness or injury that ministry personnel feel should have immediate medical attention, they may arrange by private transportation or ambulance to take my child to the emergency department of the nearest hospital and I will be notified as soon as possible. I, the parent/guardian (named below) authorize the Director or one of Calvary Pentecostal Tabernacle’s personnel to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above as needed until I arrive to be with my child.
I (named below), undertake and agree to indemnify and hold blameless Calvary Pentecostal Tabernacle, it’s personnel, it’s Directors and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Calvary Pentecostal Tabernacle, as well as of any medical treatment authorized by the supervising individuals representing the Calvary Pentecostal Tabernacle. This consent and authorization is effective only when participating in or traveling to events of/with Calvary Pentecostal Tabernacle.