Medical Release Form

For children/youth participating in church sponsored events and activities from Jan 1 through Dec 31, 2016.

  • Medical Profile

  • List any food allergies or special diet needs:
  • Permission for Medical Treatment, Photograph/Video Notice, and Release and Indemnity

    My permission is granted for church official, leader, event leader or adult present or in charge of First Aid, to obtain necessary medical attention in case of sickness or injury to my child. Also, I understand that as a participant, my child may be photographed or videotaped during church sponsored activities or events and that these photos/videos may be used for promotional materials or posted on First Baptist Church Weber City website. I, the undersigned, do hereby verify that the above information is correct and I do hereby release and forever discharge First Baptist Church Weber City and their employees or volunteer leaders from any and all claims, demands, actions or causes of action, past, present, or future arising out of any damage or injury while employed by or participating in church sponsored events or activities. I agree to indemnify First Baptist Church Weber City for any and all claims, demands, damages, injuries, costs, suits or causes of action, past, present, or future, arising out of or caused by my child while participating in church sponsored events or activities or while on property owned by First Baptist Church Weber City. Complete and sign below (youth under 18 years of age requires Parent/Legal Guardian signature)
  • Drop files here or
    Accepted file types: jpg, pdf.