Medical and Liability Release Form

Temporary Medical & Liability Release Form for TFC activities & events occurring May 2021 –May 2022
  • For May 2021 - May 2022

    Our release forms are good for one year from May to May. If you filled out last year's, you'll need to fill out this year's before going on Mission Trip or Camp.
  • MM slash DD slash YYYY
  • Additional Person to Notify in Case of Emergency

  • Doctor

  • Health Insurance

  • Scan the insurance card and attach it to this form before sending it. It works great to take a picture of BOTH sides of your card and upload that picture! If you can't upload it, just send it to ethan@tfcconnection.org
    Accepted file types: jpg, jpeg, png, gif.
  • Please Read and Sign

  • Medical and Liability Release

    I/We the parent(s)/legal guardian(s) of the above named child do hereby delegate to the TFC Connection Staff a “Power of Attorney” for the above named child for the purpose of having custody of our child and my / our consent to any needed emergency / medical treatment of said child. • In the event that I cannot be reached in an emergency during the dates specified on this form, I hereby give my permission to the physician or dentist selected by the TFC Connection Staff to hospitalize, to secure proper treatment, and / or order any injection, anesthesia, or surgery for my son or daughter as deemed necessary. • I understand that every activity sponsored by TFC Connection is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unforeseen events can occur. By signing this form, as parent / guardian, I agree to assume and accept all risks and hazards inherent in this ministry-related activity. I also agree not to hold TFC Connection, it’s employees or volunteer assistants liable for damages, losses, or injuries to the person or property undersigned. As parent / guardian, I understand that I am signing for the minor named on this form and the signature’s are to provide for the medical release, and the liability release. • In consideration for the opportunity to participate in TFC Connection activities and events, the participant (or parent/guardianif the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activities or events. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or event, or during transportation to and from the activity or event, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other represent-atives(collectivelyreferredtoasthe“activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of ministry activities and events, or transportation to and from activities and events, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise. • I/we also agree not to hold TFC Connection, it’s employees or volunteer assistants liable for damages, losses, or injuries to the participant or their personal property. As parent/ guardian, I understand that I am signing for the minor named on this form andthe signatures are to provide for the medical release and the liability release. • Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action, or otherwise, we (I) hereby assume transportation costs. • I give permission to TFC Connection to use my child’s image in photos or videos taken at TFC sponsored functions in order to publicize or promote TFC activities, including promotional materials, the TFC website, and social media pages.
  • Please enter your name to signify that you agree to the above.
  • Please enter your name to signify that you agree to the above.
  • MM slash DD slash YYYY
  • Health History

  • Please be as descriptive as possible
  • MM slash DD slash YYYY
  • Please check one
  • Please list all medications that are regularly taken and any related information.
    MEDICATION NAMETIME TO BE TAKENUMBER TO BE TAKENPURPOSE FOR MEDICATION