EYC Medical Release & Permission Form

Please fill out an individual medical form for each youth and click submit. If you would prefer to fill out a hard copy of this form please contact Elizabeth Pfeifer at pfeifer@saintmargarets.net.
Aug 2019-Aug 2020

If necessary, describe in detail the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation, handicap, disability, or condition to which your child is subject and of which the staff should be aware, and what, if any action of protection is required on account thereof. Include names of medications and dosages that must be taken. If necessary, further information may be submitted to Elizabeth Pfeifer, Youth Director, in writing at pfeifer@saintmargarets.net.
 
 
 
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PERMISSION FORM:
By clicking "yes" below, my child has permission to attend all youth activities sponsored by St. Margaret's Episcopal Church in Waxhaw, North Carolina.

This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the Church and its staff of any liability against personal losses of named child.

Activities may include, but are not limited to: cookouts, boating, water skiing, swimming, basketball, roller skating, rollerblading, games in the park, soccer, broomball, ice skating, volleyball, softball, baseball, camping, downhill skiing, snowboarding, hiking, biking, concerts, Bible studies, golfing, miniature golf, hayrides. Note: If you desire to limit your child’s participation in any event, submit your wishes in writing to the Youth Minister prior to that event.

I/We have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member.
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Description

Please fill out an individual medical form for each youth and click submit. If you would prefer to fill out a hard copy of this form please contact Elizabeth Pfeifer at pfeifer@saintmargarets.net.