The Health History is correct so far as I know, and the person herein described has permission to engage in all prescribed activities. During church events and activities, if media is taken by the church or its designees, I give full rights of the media in question for the marketing, publication and dispensing at their discretion. I hereby give permission to medical personnel selected by Greenwood Christian Church sponsor/designee to order X-rays, routine tests and treatment as prescribed. In the event of an emergency and neither my primary contact nor secondary can be reached, I hereby give permission to the physician selected by the Authorized Agent to hospitalize, secure proper treatment, order injections and/or anesthesia and/or surgery on my behalf. I further authorize the release of the above medical information to appropriate medical personnel and/or the health coverage insurance company. In addition, I have, and do hereby, release the church, its employees or agents from liability associated with participation in a church activity.
Thank you for signing up for our event!