Medical Release Form

Minor's Name *
Minor's Name
I hereby consent to participation by my child, (see name below), in this activity. I understand that my child will be under the supervision of church staff and volunteers. In addition, I agree to indemnify and hold harmless Gig Harbor Foursquare Church, and its representatives, and volunteers, from any and all claims, including negligence, arising from or relating to my child’s participation in this event.
TERMS OF ACCEPTANCE and SIGNATURE
I, the [applicant, requestor, etc.] for this [type of form], warrant the truthfulness of the information provided in this application.
Confirmation *
Emergency Medical Release
Minor's Name *
Minor's Name
I (we), the undersigned parent(s) or guardian(s) of (see name below), a minor, do hereby authorize adult volunteers of Gig Harbor Foursquare Church as agent(s) for the undersigned, to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic or hospital. I further release from any liability Gig Harbor Foursquare Church any of its ministries or leaders in the event of injury. This agreement does not apply to claims for intentional misconduct or gross negligence.
Parent/Legal Guardian *
Parent/Legal Guardian
Date of Signature *
Date of Signature
Confirmation *
Medical Information
Does your child have any medical or special needs, including medications currently being used? *