MEDICAL Form - Xtreme Camp 2024

MEDICAL Form- Xtreme Camp 2024
First*
Last*
Age*
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Student/Sponsor Cell phone*
Address*
City*
Zip*
PARENT SECTION/ EMERGENCY CONTACT
ParentEmergency Contact Name*
Home*
Cell*
Work*
Parent email*
example@example.com
MEDICAL INFO for STUDENTS or SPONSORS
Any Health Conditions if NONE please indicate*
Allergies
Dietary restrictions
Current medication send with instructions
Reason for taking above medication
RELEASE AND CONSENT TO MEDICAL TREATMENT
STATE OF TEXAS COUNTY OF COLLIN

I, do hereby consent as an adult sponsor OR as Parent or Legal Guardian ofto reasonable and necessary medical treatment in the event of the necessity therefore, and I hereby authorize the First Baptist Church of McKinney, through its employees, agents and volunteers, to provide such consent to any health care provider that may require it, sign necessary papers, and in general arrange for reasonable and necessary medical care and treatment that may be necessary. I further release and forever discharge the First Baptist Church of McKinney, its employees, agents and volunteers of and from any and all claims, demands, damages, actions, causes of action, negligence or suits of any kind or nature, whether heretofore or hereafter accruing, and whether not known, arising out of any activity of the First Baptist Church of McKinney in which my child or myself is a participant. This Release and Consent shall be valid and binding until revoked by me, in writing, delivered to Grant Byrd, First Baptist Church of McKinney, Texas. I acknowledge that I have read and understand the effect of this Release and Consent to Medical Treatment, and I am executing it for the purposes and considerations set forth.
Parent Guardian or Adult Sponsor Signature

Clear
Parent, Guardian, or Adult Sponsor Signature day of
PARTICIPATION COMMITMENT
Participant Name
I commit to follow the direction and rules of First McKinney leadership during Xtreme Camp.
Participant Signature

Clear
PHOTO/VIDEO RELEASE
I hereby grant permission to First McKinney to use photographs and/or video of me taken on 5/25/2024- 5/28/2024 at Xtreme Camp in publications, news releases, online, and in other communications related to the mission of First McKinney.
Parent Guardian or Adult Sponsor Signature

Clear
INSURANCE INFORMATION
Carrier*
Group Number*
Policy Number*
Telephone Number of Insurance Company*
Should be Empty:

MEDICAL Form- Xtreme Camp 2024

PARENT SECTION/ EMERGENCY CONTACT

MEDICAL INFO for STUDENTS or SPONSORS

RELEASE AND CONSENT TO MEDICAL TREATMENT

PARTICIPATION COMMITMENT

PHOTO/VIDEO RELEASE

INSURANCE INFORMATION