The Health history is correct, SO far as I know, and the person herein described has permission to engage in all prescribed activities except as noted.
I hereby give permission to the medical personnel selected by the participant’s Church sponsor/his designee or staff for X-rays, routine tests, and treatment for myself. In the event of an emergency and neither my primary contact nor second contact can be reached, I hereby give permission to the physician selected by the Authorized Agent to hospitalize, secure proper treatment, order injections and/or anesthesia, and/or perform surgery to myself as named above.
I further authorize the release of the above medical information to appropriate medical personnel and/or the health care insurance company. In addition, I have, and do hereby, release the church, its employees, or agents from related participation in a church activity.
I understand that if I do not have medical insurance, I, as the parent or guardian, will be responsible for any medical expenses in the event of a sickness or injury.
I understand that there are risks involved in recreation activities and other activities related to participating in church functions. I release First Baptist Church of Lake Wales, Inc. from liability for any personal injury, death, property damage, or expenses that may be suffered by anyone listed above as a result of their participation in any church-sponsored activity. This release also applies to our church's employees, officers, volunteers, and membership.
I understand and agree that neither the Church nor its trustees, representatives, employees, and agents may be held liable in any way for an occurrence in connection with the activity which may result in injury, harm, or other damages to the undersigned or members of our organization and guests, invited or not.