VBX BUILD Medical and Wavier Consent Form
Please fill out this form to provide medical and emergency information for the kids attending.
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent or Guardian Name
*
First Name
Last Name
List any medical conditions
*
List any medications your child is currently taking
*
Doctor's Name
First Name
Last Name
Doctor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Card ID Number
*
Medical and Wavier Consent
*
I give my consent for my child(ren) to receive necessary medical treatment in the event of an emergency during this event.
By checking this box, I acknowledge that my child(ren) has permission to participate in all event activities. I understand that every reasonable precaution will be taken to ensure the safety of all participants; however, I agree not to hold the church, its staff, volunteers, or representatives liable for any injury, accident, or incident that may occur while participating in event activities, except as required by law.
Submit Medical Form
Should be Empty: