HEALTH HISTORY (please explain any conditions we should be aware of)

INSURANCE

The church's insurance is secondary insurance. If you have medical insurance, you carrier will be billed for medical charges in the case of illness or injury while participating in church sponsored activities.

MINOR LIABILITY RELEASE

I give permission for the child listed to participate in all activities as part of the ministry of Mansfield Bible Church (MBC) of Mansfield, TX. Every activity sponsored by this church is carefully planned and adequately supervised. However, even with the best of planning and precautions, unforseen events can occur. As parent or legal guardian of said minor, I accept full responsibility for my child's participation in MBC activities including transportation to and from any location in connection with MBC events. I also agree that I will not hold MBC, its employees or volunteer workers or any members liable for damages, losses or injuries to the above named minor. I will assume full responsibility for all medical costs incurred in the event of an accident or other incident requiring medical treatment. I release MBC from any liability. In the event of an emergency in which my child is in need of immediate hospitalization, medical attention or surgery, and if reasonable efforts to contact me or my spouse have been unsuccessful, I give my permission for the Children's or Youth Minister, or MBC volunteer to give consent for any emergency medical treatment deemed necessary. It is understood that my child will obey all regulations and follow the instructions of the leaders. I agree to pay any expenses, including the cost of my child being sent home if this is deemed necessary. I understand that this form and my signature are for both medical and liability release.