Adult Leader Release Form

I have completed the contact information, the medical history information, and provided a copy of the insurance card. Effective immediately. I assume all risk and hazards and do hereby release and agree to hold harmless Coker United Methodist Church and its servants, volunteers, agents and employees from all liability for personal injury or property damage for all actions taken in good faith during church activities. Additionally, I hereby release and agree to hold harmless the church and its servants, volunteers, agents, and employees from all liability in the event that I contract COVID-19 virus during a church activity. Inthe event I cannot be reached or cannot communicate in an emergency, I hereby give my permission to the physician, hospital, or medical service selected by the leaders of the church to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for myself as named above. It is understood that a conscientious effort will be made to communicate with me or the emergency contact listed before any action is taken. I accept responsibility for any and all expenses incurred from medical treatment provided. I have read this release and understand its term and execute it voluntarily and with full knowledge of its significance.

Coker United Methodist Church I Family Ministries I 231 E. North Loop Rd., San Antonio, TX 78216 I 210.494.3455