Student Medical and Travel Release Form 2021/2022
The following health record must be filled out for each student by the parent or legal guardian. The student may not be a part of any College Church extracurricular activity until we have a completed form on file. A new form must be filled out at the beginning of each school year. If you have any questions, please contact a College Church ministry staff member.
Treatment: In case of emergency, I hereby give permission to the physician selected by the College Church staff and/or assigned personnel to hospitalize, secure treatment for, and to order injection, anesthesia, and/or surgery for the student named above.
Punctuality: I agree that my student should be punctual for designated departure times. If my student is more than 15 minutes late for an announced departure, I understand that College Church may leave for the event without my student. I agree that it is my responsibility to ensure that my student is picked up at the designated time at the church. I understand that College Church reserves the right to exclude my student from future events if I am continually late in either dropping off or picking up my student.
Dated: May 26, 2022