NOTE: This must be completed by the parent/guardian. If you are not the parent/guardian for this child, please use the printable Medical Release & Liability Waiver for the parent/guardian to complete.
I, hereby give employees and volunteers of Gray United Methodist Church permission to provide first aid care for my child listed below. In the event I cannot be reached, I hereby authorize Gray United Methodist Church's employees and/or volunteers to transport my child to the emergency room, and I hereby grant my consent for the hospital and its medical staff to provide my child with emergency medical treatment that a physician deems necessary (including anesthesia). My student may be taken to and cared for at the nearest hospital, and I agree to accept all financial responsibility for all medical expenses incurred.
I, on behalf of myself and my child, our personal representatives, heirs and assigns, release and covenant to hold harmless Gray United Methodist Church, its employees, volunteers, and agents from all demands, claims, and causes of action I or the child may have for personal injury, property damage, economic loss, or emotional distress, or otherwise, arising from, or in any way relating to, this activity.
I have carefully read the foregoing permission/release, know the contents there of, and sign the same as my own free act.
NOTE: You may enter the Chid's Doctor's Name, Insurance Provider, and Policy Number once, if the information is the same for each child.