Form | Onecho Bible Church

Onecho Bible Church Medical Precautions, Restrictions, And Release Form: Moscow Axe Throwing 11/17/2024

If a medical emergency should arise regarding my child, I hereby give permission to the ministers, chaperones, or representatives of Onecho Bible Church to select a physician and/or hospital for my child's care and to administer any emergency medical treatment that my child may require. I also give such medical personnel and/or hospital my permission to treat my child at the request of representatives of Onecho Bible Church. I give representatives listed herein, permission for sign-up and give permission for activities pertaining to this trip. I understand Onecho Bible Church cannot assume responsibility for medical expenses for my child and agree to bear such responsibility and pay any such expenses incurred with respect to such medical emergency. Onecho Bible Church can only cover up to $10,000 of secondary medical insurance.I also relieve Onecho Bible Church, its ministers, chaperones, and representatives from any claim/or liability or damages as a result of any illness or injury, including death, or any property damage which may be suffered by my child during scheduled activities of Onecho Bible Church, including, but not limited to, the event listed above. I also understand that these activities have an element of risk and that my child must listen carefully to all instructions, obey all rules, never participate in an activity without proper Onecho Bible Church supervision. Failure to follow the above agreement will result in my child’s removal from activities and if necessary, my child may be returned home at my expense. Also, including transportation in connection therewith, regardless of the cause thereof. I further acknowledge that the representatives of Onecho Bible Church shall not be responsible for supervising the taking of any medication required by my child during such trips or activities. I UNDERSTAND THAT I CAN REVOKE THIS RELEASE AT ANY TIME BY PICKING UP THIS DOCUMENT FROM ONECHO BIBLE CHURCH or the trip leader.

Youth First name

Phone

Date of Birth

Insurance Company Name

Insurance Number

Youth Last name

Emergency Contact Name

Emergency Contact Phone

RX #

Parent/Legal Gaurdian Signature

Select a date

I hereby give my consent tto the terms & conditions to the above form and checking this box gves my digital signature on submission.

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