Medical/Liability Release

MEDICAL RELEASE

In the event that an emergency should arise while (child's name)_____________________________________________
is participating in a Templeton Community Church related trip or event, which would require medical and/or surgical treatment, I authorize those working or volunteering for Templeton Community Church to seek and obtain appropriate and necessary medical care and treatment for the above named individual.

Signature________________________________________

Phone Number______________________ Cell Phone________________________ Pager________________________

Date__________________ Relationship to Child Mother [ ]Father [ ] _________________________________________

Alternate Contact Name and Phone Number (if we are unable to contact parents)

__________________________________________________________________________________________________

Insurance Co._____________________________________ ID/Policy #_______________________________________

Allergies/Medication/Other Medical Information___________________________________________________________

_________________________________________________________________________________________________

LIABILITY RELEASE

I, the undersigned, hereby agree to authorize (child's name)_____________________________________
To participate in the Templeton Community Church related trips and events. I understand and assume all risks associated with water hazards, sports, games, and all other activities associated with programming through Templeton Community Church. I agree to hold Templeton Community Church, employees and volunteers, and anyone related to the programs at Templeton Community Church harmless of any liability whatsoever from accident or serious injury to my child.

Parent Signature________________________________________________________________________

Date__________________________________ Relationship to Child_____________________________