Who can pick up your student? list those individuals who are allowed to pick up your student
Fair or Poor Health explanation please explain why the participant’s health is fair or poor
Medical Issues(Required) share any medical conditions, medications, &/or allergies the participant might have; enter “n/a” if this does not apply
List any medical conditions for which the participant is currently being treated:(Required) enter “n/a” if this does not apply
List any medications the participant is currently taking:(Required) enter “n/a” if this does not apply
List any medications or substances the participant is allergic to:(Required) enter “n/a” if this does not apply
Release Section By completing this form you are acknowledging that you (& your student) have read & understood the Conduct & Responsibility Guidelines, the Chaperone/Volunteer Guidelines, as well as the Medical, Photo & Hold Harmless Release Forms.
Medical, Hold Harmless, & Photo Release Authorization(Required) Do you; (1) give your permission for an attending physician or hospital to administer medical care if deemed necessary by the leader(s) of First United Methodist Church of Panama City and the physician or hospital staff during the event. (2) I, therefore, do hereby release from all claims and forever hold harmless the directors, officers, agents, and employees of First United Methodist Church of Panama City, from any and all claims and demands for personal injury, sickness, and death, as well as property damage and expenses, of any nature, incurred by myself (or my child under 18 years of age). (3) And furthermore, give FUMC rights & permissions to photo/video & distribute as they see fit the participant. And the participant discharges and agrees to save harmless First United Methodist Church of Panama City from any liability for violation of any personal or proprietary right that I may have in connection with said images and with the use thereof.