Medical Release Form
I, the parent or legal guardian of the student listed on this form, certify that he/she has my full approval to participate in events with Mechanicsville Church of Christ (MCC). The student identified on this form understands that all students are expected to abide by the rules and are directly responsible to the MCC Staff or an appointed sponsor.
Further, I do release and hereby hold blameless MCC and its employees and sponsors from any and every claim arising, which may be asserted to me or by any member of my family by reason of participating in any activities associated with said trip.
Further, I do authorize the MCC Staff or an appointed sponsor, in the event that I cannot be reached by phone, to give consent to a physician and/or hospital for emergency medical or surgical treatment while on said trip. It is understood that I will assume all responsibility for any expenses which may be incurred for said emergency treatment.
Further, I do certify that said student is covered by adequate accident/health insurance. My consent and signature are given below. I have read and agree to the information given in this entire form.
Please initial that you have read and agree to the statement above. *
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