EMMANUEL BIBLE CHURCH
EMMANUEL YOUTH MINISTRIES
SEASON RELEASE FORM
2008-2009
Please download, complete and return this form to Emmanuel Youth Ministries
I am giving permission for:
___________________________________________________________________
to attend all Emmanuel Youth Ministry events for the school year
June 1, 2008 to August 31, 2009
In the event that he/she is injured while under
the care of Emmanuel Bible Church
and its representatives and requires the attention of a doctor, I hereby consent
to
and will be responsible for any medical treatment as deemed necessary by a
licensed physician.
I further agree to hold the licensed physician, the medical facility, Emmanuel
Bible Church
and its representatives free and harmless of any claim, demands, or suits for
damages arising from
the authorization and provision of such medical treatment.
I understand the nature of these events and do hereby release Emmanuel Bible
Church
and its representatives from any liability due to accident or injury incurred by
my child.
Medical Conditions:
________________________________________________________________________
__________________________________________________________________________________________
Medications being taken by my child:
_________________________________________________________
__________________________________________________________________________________________
Allergies (medication/food/environment):
____________________________________________________
__________________________________________________________________________________________
Special Needs: _____________________________________________________________________________
Emergency Contact Name and Telephone:
____________________________________________________
__________________________________________________________________________________________
Insurance Company and Policy Number:
______________________________________________________
__________________________________________________________________________________________
Signature of Parent/Guardian:
______________________________________________________________
Date:
_____________________________________________________________________________