MEDICAL and

release form

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IN CASE OF EMERGENCY

HYLAND HEIGHTS BAPTIST CHURCH LIABILITY AND MEDICAL AUTHORIZATION

We, the parents or legal guardians of                                                                        do release Hyland Heights Baptist Church, its staff and volunteers of any responsibility for accidental injuries sustained during HHBC Student Ministry activities. I hereby grant for the above named teen my permission to participate in all HHBC Student Ministry activities and allow the Student Ministry to use images (digital or otherwise) of my student for promotional and acknowledgement purposes.

In case of an emergency, we the parents or legal guardians of                                                                        hereby give permission to the physician and/or hospital personnel selected by the Hyland Heights Baptist Church Student Ministry personnel to hospitalize, secure proper treatment, and to approve injection, anesthesia, or surgery for my child as deemed necessary.

By checking this box you are providing your electronic signature on this Agreement and indicating that you acknowledge, agree and demonstrate that your electronic signature on this Hyland Heights Baptist Church Liability and Medical Authorization will bind you to the document the same as if you had signed a paper copy of the document with an ink pen.