Children’s Choir Medical Release

First Presbyterian Church strives to provide exceptional care for your child(ren) as they participate in church activities. To properly equip our staff and volunteers when parents are not immediately present, especially in an emergency situation, we ask that parents please fill out the following Medical Release.

Children's Choir Medical Release

  • This form is valid for all children's choir activities from August 2018 through May 2019.

    I hereby release First Presbyterian Church and its staff and sponsors from responsibility and liability for any injury or illness that my child may sustain during church-sponsored activities. In the event of an emergency, I hereby authorize an adult leader of the activity, as agent for me, to consent to any examination or treatment by 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.
  • Parent Information

  • Emergency Contact

    Parent/legal guardian will be contacted first in case of emergency. In case parent/guardian cannot be reached, please provide a non-parent emergency contact.
  • Insurance & Doctor Information

  • optional
  • optional
  • Entering your name here acts as an electronic signature to this form.
  • MM slash DD slash YYYY
  • A confirmation email will be sent to this email address upon completion of form.

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