GCBC Medical Release 5/2024-5/2025 - Grace Community Bible Church

GCBC Medical Release 5/2024 - 5/2025

Grace Community Bible Church 5121 FM 359, Richmond, TX 77406 MEDICAL RELEASE FORM Valid for ALL events from May 2024 to May 2025 - As a parent/legal guardian of: Student/Participant's Name(Required)

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My signature indicates that: 1. I give permission for the participant to participate in all the activities associated with the event. 2. I understand that all reasonable safety precautions will be taken at all times during the event. In the case of an emergency and neither the secondary contact nor myself can be reached, I authorize any treatment by a hospital and/or physician deemed necessary for the participant as provided on the registration form. I understand the possibility of unforeseen hazards and know the inherent possibility of risk during the event. 3. I have, and do hereby, release Grace Community Bible Church, its employees, elders, deacons, agents and supervising adults from liability resulting from or in any manner arising out of any injury or damage which may be sustained on account of the participant’s participation in this event.: Parent or Guardian Name(Required)

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Student/Participant's Name(Required)

First Last

Student/Participant's Birth Date(Required)

Cell Phone

Home Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Secondary Emergency Contact Name(Required)

First Last

Secondary Emergency Contact Phone(Required)

Relationship to Participant:(Required)

Allergies and/or medical conditions the participant may have (include food allergies):

Parent/Guardian Signature & Date(Required)

Signature Date

Student/Participant's Name(Required)

First Last

Parent/Guardian Signature & Date(Required)

Date of Signature(Required)