Medical and Liability Release

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    Minor Liability & Medical Release Form

    440 Frederick St. Santa Cruz CA 95062 Phone (831) 429-1162 FAX (831) 429-9575
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    This is a required question
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    Parent Information

    This is a required question
    This is a required question
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    Emergency Contact

    Local Person other than parent to contact in the event of an emergency
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    This is a required question

    Health History

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    Health Insurance

    Our church's insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in the case of illness or injury while participating in any church sponsored activity on or off campus.
    This is a required question
    This is a required question
    This is a required question
    This is a required question

    Liability Release

    Every activity sponsored by this church is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unforeseen events can occur. It is your intention, as the parent or guardian of the minor listed on this form, to exempt and relieve SCBC and it's employees or volunteers from liability for personal injury, property damage or wrongful death caused by any act of negligence on the part of SCBC and it's employees or volunteers. This includes all risks and hazards inherent in any and all church-related social and sport activities including transportation to and from off campus activities. You acknowledge there may be potential health hazards inherent in some activities and that your child participates at his/her own risk. As parent of legal guardian, you will assume full responsibility for your child's participation in SCBC activities and understand that your child is responsible for applying any an all instruction and rules given to them for any activity or activity incident thereto some of.

    Minor's Medical Release

    I give permission for my child,
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    Parent/Guardian Responsibility & Consent

    To participate in all activities as part of the ministry of Santa Cruz Bible Church of Santa Cruz, California. I will assume full responsibility for any medical costs incurred in the event of an accident or other incident requiring medical treatment. I release S.C.B.C. from any liability. In the event of an emergency in which my child is in need of immediate hospitalization, medical attention or surgery, and after reasonable efforts have been made to contact me or my spouse and we cannot be located for the purpose of consenting thereto, consent for the emergency attention may be given to any person standing loco parentis to my child pursuant to A.R.S.S 44-133. It is understood that my child will obey all regulations and follow instructions of the leaders. You understand that this form and your signature is for medical and liability release.

    Parent Permission (Transportation)

    I further give permission for my child to be transported to and from events by hired and volunteer drivers authorized by the Children's Director.
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    This is a required question

    The above Liability and Medical Release covers any and all activities on or off campus, sponsored by or associated with SCBC from January 1, 2018 to January 1, 2020.

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