9408 Wilson Ave SW, Byron Center, Mi 49315

(616) 878-1619

Email: parishoffice@stsebastianmi.org

2018-2019 Medical Release Form

2019-2020 Medical Release Form

THIS FORM SHOULD BE USED FOR:
1. By anyone who is not registered in our youth ministry but would like to participate in an event.
2. For any parent who needs to update their youth's medical release form.
  • Medical Treatment Release

    As the parent or legal guardian, BY CLICKING “SUBMIT” BELOW I hereby authorize first aide/medical treatment for my youth(s) who is/are listed above in the event of an emergency which may endanger her/his life, cause disfigurement, physical impairment, or undue discomfort if delayed. It is understood that efforts will be made to contact the emergency contact person listed on this form as soon as reasonably possible. In the event that my youth(s) requires my authorization for treatment and I cannot be reached in an emergency, I hereby give my permission to the physician selected by the activity leader to hospitalize, secure medical treatment, and/or order an injection, anesthesia or surgery for my youth(s) as deemed necessary. Furthermore, BY CLICKING “SUBMIT” BELOW I understand all reasonable safety precautions will be taken at all times by the parish and its agents during youth programing and events. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to waive and release, and indemnify and hold harmless Saint Sebastian Church, any and all affiliated organizations, its/their employees, agents, representatives, volunteers and drivers, from any and all claims my child may have, excluding claims for intentional misconduct or gross negligence, arising from or relating to my child’s participation in this event.