Forms

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Youth Medical/Liability Release

Youth Medical/Liability Release Form

Parent/Guardian Name*
First Last
Name of Student(s)*

Click plus sign to add more students.
Activity*
Date of Activity*
Have you filled out this form before?*
- Yes
- No
Has your information changed?*
- Parent/Guardian Address/Phone
- Medical Information
- No
Student's Birthday*
Have more than one student?*
- Yes
- No
2nd Student's Birthday
3rd Student's Birthday
4th Student's Birthday
Parent/Guardian Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Parent/Guardian Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Parent/Guardian Phone Number*
Parent/Guardian Phone Number*
Emergency Contact Name
First Last
Emergency Contact Phone Number
Insurance Company*
Insurance Company*
Policy #*
Policy #*
Primary Doctor*
Primary Doctor*
Doctor's Phone Number*
Doctor's Phone Number*
Any allergies, conditions, medications, or medical concerns?
Any allergies, conditions, medications, or medical concerns?
Consent*
I agree
I understand all reasonable safety precautions will be taken by Hager Park Church and its agents during events, trips, and activities. I also understand the possibility of unforeseen hazards and know the inherent possibility of risk. I hereby agree to release and forever discharge, and agree to hold harmless, Hager Park Church, its leaders, employees, volunteer staff from any liability, and claims for damages, losses, sickness, or injuries.

I understand that if medical attention is needed, for this child during this activity, every attempt will be made to consult the listed contact person on this form. If, however, the persons listed cannot be reached, I give my permission to the activity leaders to secure the services of a licensed physician or surgeon to provide medical services deemed necessary for the well-being of the child.
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Photography Opt-Out

Photography Opt-Out Form

As the church is progressing, we are going to be taking more photos of various events happening in the church. These pictures will be used for various printed and online material. However, if you would like to opt-out of having a photo of you used either in printed or online material please fill out the form below.

Name
First Last
Opt-Out
I want to opt-out of having a photograph of me used in both printed and digital material.
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Youth Medical/Liability Release Form

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