Medical Release Form

Health Release Form

I hereby grant permission for my child to participate in the activity of the Grace Assembly of God Church.

I understand that my child participates in these activities at their own risk and that the Grace Assembly of God Church and its adult supervisors are not liable for any injury personal or otherwise to my child or caused by my child. Should any problems arise concerning the behavior of my child that would require them to return home prior to the end of the activity, I will pay for his or her return or come pick my child up. I authorize the treatment, by a qualified and licensed medical doctor, of the minor listed above in the event of any medical emergency which, in the opinion of the attending physician, is necessary and I/we cannot be reached after a reasonable effort has been made to secure my personal consent.

I am responsible for any medical expenses. *
(Parent or legal guardian)
Emergency Contacts: