Medical/Allergy Form

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Contact Information

 
 
 
Parent/Guardian Information

 
 
 
 
 
Additional Emergency Contact

 
 
 
Doctor Information

 
 
 
Medical Condition(s)

 
 
 
 
 
 
 
 
Medical Release

In consideration of my child’s (name listed above) opportunity to participate in Calvary Baptist Church’s activities and programs, I acknowledge and accept the risks of injury associated with participation and transportation to and from any and all activities and programs of Calvary Baptist Church. I accept personal financial responsibility for any injury or other loss sustained during the activities or programs of Calvary Bapstist Church or during transportation to and from such activities and programs, as well as for medical treatment rendered to my child that is authorized by Calvary Baptist Church, its leaders, employees, volunteers, or agents. I specifically consent to allowing my child to be transported to receive emergency care and to be responsible for all financial charges for such emergency care. I release and promise to indemnify, defend, and hold harmless Calvary Bapstist Church, its leaders, employees, volunteers, and agents from any and all injury or loss arising directly or indirectly out of the activities and programs of Calvary Baptist Church or transportation to and from such activities and programs, whether such injury arises out of the negligence of Calvary Baptist Church, my child, or otherwise. 
 

Description

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