Memorial UMC Liability Release Form and Medical Consent

I/We, the parent or guardian of ____________________________________ hereby give my/our approval for my child’s participation in any and all of the activities of the Memorial United Methodist Church.  I/We assume all risks and hazards incidental to such participation, including transportation to and from those activities.  I/We hereby release, absolve, indemnify and hold harmless Memorial UMC, its officers and volunteers.  In case of injury to the above named youth, I/we hereby waive all claims against Memorial UMC, its officers and volunteers, whether the result of negligence or for any other cause, except to the extent and in the amount covered by accident or liability insurance.  This release applies to all church events for one calendar year from the date of the signature below.  

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Parent/Guardian Signature                                                E-mail Address

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Date

Consent to Medical Care and Treatment

I, (parent or legal guardian), authorize all medical, surgical, diagnostic and medical procedures as may be formed or prescribed by a treating physician for ________________________(youth name), in the event that I cannot be reached in an emergency.  This consent applies to all church events for one calendar year from the signature below.  

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Parent/Guardian Signature                                                Date

Emergency Contact Information

Parent (name, number)                                ___________________________________________________

Emergency Contact, (name, number, relation)         ___________________________________________________

Physician, (Name, number)                                ___________________________________________________

Medical Insurance, (Name, policy number)                 ___________________________________________________

Known Medical Conditions/Allergies/Current Medications

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