Text Text

Medical Release Form

Cornerstone, an Evangelical Free Church Youth Group Medical Release Form

In an effort to consolidate paperwork and to minimize confusion on events, we are asking you to complete the form below. Should pertinent information change (like insurance companies or allergies) please inform our office. It will be important for you to fill out a permission slip for major outings; we will provide these for you.
IF WE CANNOT CONTACT YOU IN CASE OF EMERGENCY, CONTACT:
As the parent of the above listed child, I give permission to a licensed physician to diagnose, hospitalize, anesthetize, or perform surgery on said child for any accident that occurs on church functions throughout the year beginning July 1, 2023 August 31, 2024. I hereby release from liability all church staff (paid or volunteer) of Cornerstone, An Evangelical Free Church, in Annandale, VA and the church itself. I understand that every effort will be made to contact me before any actions are taken.