Episcopal Diocese of San Diego
Medical Release and Waiver of Liability
I hereby release the Episcopal Diocese of San Diego, and St. Michael’s by-the-Sea Episcopal Church, its directors, officers, employees and volunteers from responsibility and liability for any injury or illness that my child/youth, OR I as an adult participant may sustain during this activity. In the event of an emergency, I hereby authorize an adult leader of this activity, as agent for me, to consent to any x-ray examination, medical, dental or surgical diagnosis, treatment and hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate), licensed to practice under the laws of the state where the services are rendered, either at a doctor’s office or in any hospital. I expect to be contacted as soon as possible. The medical information stated above is true and accurate to the best of my knowledge and belief.