Medical Release Form
Please read the following form and fill out accordingly. I do by swear and declare that I am the parent or legal guardian of the child/children herein listed/registered and that there are no court orders preventing the parent or guardian from granting this authorization. In case of an emergency, the parent(s) or legal guardian(s) should be contacted using the provided emergency contact information. The undersigned being the lawful parent(s) and/or guardian(s) of the above child, hereby consents to the participation by the Child(ren) in Vacation Bible School conducted by Faith Fellowship Church (Organizer) Children's Ministry and to the participation of the Child in all events relating to the activity. I hereby waive and release Faith Fellowship Church (Organizer) and all individuals, staff members or volunteers working in connection with the above-mentioned activities from any and all possible claims for injury to person or property which might arise in connection with my Child's participation in these activities. The undersigned hereby further authorize(s) any of the staff, employees, agents and representatives of Organizer to provide for, approve and authorize any health care at any hospital, emergency room, doctor’s office or other institution; employ any physicians, dentists, nurses, or other person whose services may be needed for such health care; review and if necessary disclose the contents of any medical records; execute any consent form required by medical, dental or other health authorities incident to the provision of medical, surgical or dental care to the child. Health care shall include but not be limited to the administration of anesthesia, X-ray examination, performance of operations, diagnostic and other procedures. If there is no medical emergency, the Organizer will first use reasonable efforts to contact the parent(s) and/or guardian(s) before administering or authorizing any treatment. Notwithstanding other provisions in this Consent Form, Organizer shall not have the authority to withhold or withdraw life-sustaining procedures for the Child. This Consent Form may be revoked at any time before the expiration date with written notice to Organizer.
