2022-2023 Medical and Surgical Wavier

September 1, 2022-Agust 31, 2023 | This is our Medical and Surgical Waiver for 2022-2023. On completion of this waiver, your student will not require additional waiver, unless the facitly/group requires an additional waiver.

INSTRUCTIONS:


The 2022-23 Medical and Surgical Waiver will apply to all student events, trips and projects from September 1, 2022 through August 31, 2023. In the event that a participant needs medical attention, this waiver will provide an adequate and current record of the student’s medical information, and parental permission for First Baptist Festus/Crystal City as well as the hospital. Please be thorough with each answer. It is the responsibility of the parent or guardian to keep this information current.

Personal Information

 
 
 
 
 
 
 
 
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Medical Infromation

 
 
 
 
 
 
 
 
 
 
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Medical Insurance

 
 
 
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Waiver

TO BE FILLED OUT BY PARENTS OR LEGAL GUARDIANS OF PARTICIPANTS UNDER 18 YEARS OF AGE


I, the parent and/or legal guardian of the student above, a minor, hereby acknowledge that said minor is presently under my care, custody and control. I hereby give said minor permission to participate in any and all activities at First Baptist Church of Festus/Crystal City, Missouri for which he/she, with my approval, registers to participate. I further expressly grant permission for said minor to participate in all activities while an active participant on trips and church events. If in the event there arises an emergency necessitating medical or surgical attention or emergency transportation, I hereby consent and give my permission to the First Baptist Church of Festus/Crystal City staff, its representatives, the sponsors, or any attending physicians to make such decisions and to perform such medical treatments and/or surgery or use emergency transportation upon/for said minor which may, in their sole discretion, be necessary and proper under the circumstances.  I, the undersigned parent and/or legal guardian of said minor, do hereby release, acquit, discharge and covenant to indemnify and hold harmless First Baptist Church of Festus/Crystal City its staff and/or representatives, the sponsors, and/or any attending physician from any and all claims, damages, actions, and causes of action of any nature, including but not limited to negligence, damages, and liabilities, arising out of the treatment of any sickness and/or accident and any related risks and dangers thereto, from financial responsibility for all medical treatment provided during the attendance of any student ministry events. I also assume responsibility for providing and paying for the return transportation of said minor from the event location should it be necessary for disciplinary reasons.

 
**By entering my name in the box above, I am providing my diital sinture on this form. I also indicate by my signature that all the information above is accuate. 

Description

September 1, 2022-Agust 31, 2023
This is our Medical and Surgical Waiver for 2022-2023. On completion of this waiver, your student will not require additional waiver, unless the facitly/group requires an additional waiver.