Medical Release and Permission Form

Permission Slip for Sonlight Wesleyan Church Bluffton, Indiana

By signing the permission slip and medical release, you as the parent/guardian are allowing your child to participate in all programs/activities from
Jan. 1, 2024 - Dec. 31, 2024

Child Information

Child Contact

Parent/Guardian Information

Parent Contact

Emergency Contact

Insurance Information

I understand that if medical intervention is needed for this child, every attempt will be made to consult the contact persons listed on this form. If, however, those persons cannot be reached, I give my permission to the activity leaders to secure the services of a licensed physician to provide medical treatment that is deemed necessary for the well-being of this child. I understand all reasonable safety precautions will be taken at all times by Sonlight Wesleyan 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 agree to release, forever discharge and hold harmless Sonlight Wesleyan Church, its leaders, employees, and volunteer staff from any and all liability and claims for damages, losses, sickness, or injury incurred by this child.