In the event that I cannot be reached in an emergency during the dates specified on this form, I hereby give my permission to the physician or dentist selected by the church leadership to hospialize, to secure proper treatment, and/or order an injection, anesthesia, or surgery for my son or daughter.
Every activity sponsored by this church is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unforseen events can occur. By signing this form, the parent/guardian agrees to assume and accept all risks and hazards inherent in church related activities. They also agree not to hold this church or its employees or volunteer staff liable for damages, losses, or injuries to the person or property undersigned. The parents or guardians understand that they are signing for a minor listed on this form and the signature is both a medical and liability release.
(Student)First Name Last Name has no medical insurance. I/We (Parent/Guardian), First Name Last Name accept full responsibility for any medical expenses incurred as a result of accident or injury that occurs during a FOOTHILL CHURCH sponsored youth activity.
Thank you for filling out this form, and we are excited to see your student soon!