2016-2017 CrossPoint Sports Permission and Medical Release Form - Maywood Evangelical Free Church

 

(Browser cookies must be enabled)

 
 
 
 
 
 
 
 

Emergency Information

 
 




In Case of Emergency, when parents are not available, please contact:





Medical Insurance Information

 
 
 
 

Medical Information

 
 
 

Although it is our sincere desire to provide a safe environment for our children, we also recognize that accidents can, and sometimes do, happen. If such a situation should occur, our first response will be to contact you, the parent, unless it is a life-threatening injury where it would be wise to seek immediate medical attention. The purpose of this form is to allow us to obtain first aid care for your child if we are unable to contact you.

Since this ministry is arranged for the benefit of those participating, it is understood that Maywood Evangelical Free Church and its employees and adult supervisors will execute caution, good judgment, and care but cannot be responsible in case of accident, injury, and loss or damage of property in connection with any trip/activity, and the undersigned will save them harmless from all such claims.

I hereby authorize and give my consent for the adult CrossPoint Sports Ministry staff to arrange for performance on or administration to my student for any necessary emergency, medical, or surgical treatment. I understand that staff will attempt to contact me by phone before relying on this authorization.

I request and authorize medical personnel to provide all reasonably necessary medical care, including but not limited to medical transport, hospital tests, such as pathology, radiology, anesthesia, surgery and prescription drugs advisable for the health of my child.

Signing this authorizes the above student to participate in the CrossPoint Sports Ministry.

I further agree to admonish the child participating in the program to exercise care, to be well-behaved and in all things obedient to and under the direction and control of those adults in charge.