2011-2012 Youth Medical Release Form

Parental Consent

I hereby give consent for the above student to participate in events sponsored by Church at the Crossing Student Ministry during the Calendar Year of 2011/2012. In case of emergency and the unlikely event that I can not be reached, I hereby authorize and adult to chaperone to secure the necessary medical treatment at any registered hospital, clinic, or doctor's office as needed. I hereby relieve Church at the Crossing and its directors, supervisors, and sponsors from any and all liabilities for any and all sickness, accidents, and injuries and/or and other cause whatsoever while in attendance at a Church at the Crossing Student Ministry sponsored event. Further, as a parent or guardian of the minor named above, I do hereby consent that my son/daughter may receive emergency medical treatment from any physician, hospital or other medical center without necessity of first notifying me and do further agree to hold blameless any physician, hospital or other medical center for rendering such services.