Parent/Guardian/Emergency/Other Contact Information:
MEDICAL RELEASE INFORMATION
As a parent / guardian, I do hereby authorize the treatment by a qualified and licensed medical doctor of the above minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his / her life, cause disfigurement, or undue comfort if delayed. This authority is granted after all reasonable effort has been made to reach me. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence for the Awana Club year Sept 9, 2022 through May 26, 2023.
Annual Fee is $35.00.
Please make checks payable to
Mandarin Baptist Church or MBCSFV
("Awana" in note section)
Cash accepted also