Medical Insurance Provider
Does the student have any major illnesses or allergies that we need to be aware of?
If necessary, describe in detail any physical and/or psychological ailment, illness, propensity, weakness, limitations, handicap, disability, or condition to which you child is subject and of which the staff should be aware, and what, if any action of protection is required on account thereof. Also, please let us know of medications and dosages that must be taken.
This consent form gives permission to seek whatever medical attention is deemed necessary and releases First Christian Church and its staff of any liability against personal losses of named child.
Activities may include but are not limited to: ice skating, basketball, roller skating, games, soccer, broom ball, dodge ball, concerts, Bible Studies, jumping on inflatables, riding a mechanical bull, volleyball, camping, playing video games. Note: if you desire to limit your child’s participation in any event, please submit your wishes in writing to the church youth pastor prior to the event.
I/We the undersigned have the legal custody of the student named above, a minor, and have given 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 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 child'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 student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member.
Parent/Guardian's Signature (or Student Signature if over 18)
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