Parental Contact Information
Waiver of Liability
This medical release will cover participation at the Jordan YMCA Pool on Tuesday, June 25, between 10AM and 4PM.
This permission includes church/camp transportation to and from the event and during attendance at the event. I assume full responsibility for my son/daughter while participating in this activity and agree that he/she be in submission to those in authority.
As a parent or guardian, I do, herewith, authorize the treatment by a qualified and licensed medical doctor of the registered camper, in the event a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authorization is granted only after a reasonable effort has been made to reach me.
Emergency Contact Information
I understand that Colonial Hills Baptist Church will provide medical care to my child for injuries or illnesses. I understand that Colonial Hills Baptist Church reserves the right to bill me for excessive medical supplies used. I understand that all offsite medical expenses will be directed through parent's health insurance policy. Colonial Hills Baptist Church does not provide secondary health insurance coverrage. In case of medical emergency, I understand that every reasonable effort will be made to contact me. In the event I cannot be reached, I give permission to secure reasonable medical treatment for my child. I understand if my child has a communicable disease, sickness, or lice and/or nits, Colonial Hills Baptist Church reserves the right to take appropriate precautions, including dismissal.