Medical Form A Medical Release Form for Minor Children is required for each child attending Vacation Bible School 2021 at Hope Presbyterian Church. ONLINE MEDICAL RELEASE FORM FOR MINOR CHILDREN Medical Form for VBS 2022 Needed for a minor to participate in a special activity Child's Name* First Last Date of Birth* MM slash DD slash YYYY Age* Sex* Male Female Address* Street Address City ZIP / Postal Code In case of emergency contact* Phone 1*Phone 2Phone 3Doctor's Name* First Last Doctor's Phone*Date of last tetanus booster shot* Date of last physical* Allergic to (reply NONE if no allergies)* Any medical needs? (Reply NONE if no special needs)*Medication presently being used (reply NONE if no meds)*Limitations or restrictions while at activity (reply NONE if no restrictions)*Insurance Compancy/Policy # Consent*In case of emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give Hope Presbyterian Church permission to act on my behalf in seeking emergency treatment for my child in the event the representatives of the church deem such treatment necessary. I give permission to those administering emergency medical treatment to do so, using those measures deemed necessary. I absolve Hope Presbyterian Church and their designated representatives from liability in acting on my behalf. I agree.Name of Parent/Guardian submitting this form* First Last Date of submission* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. Δ