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  • Authorization for Medical Release


    Authorization for Medical Aid and Release of Liability

    General Information

  • Insurance Information

  • Medical Information

  • Release of Liability

    Please list any activities in which your child is not to participate:
    Curtis Baptist School, including employees and representatives of the aforementioned organizations, shall be held harmless from any suit, action, damages, or claims at law or otherwise, resulting from or arising out of any injury, accident, or illness that may befall the student-athlete / my child and/or his/her property while participating in Curtis Baptist School sponsored events or activities. If the participant is a minor, this covenant is applicable to the afore signed and his/her parents or guardian.
    The undersigned parent or guardian hereby authorizes the sponsor, sponsor's agent, or employees to take such action as may be necessary for the medical care or treatment including the administration of medication, performing of surgery, or such other action as needed in the event on injury or illness of participant when parent or guardian cannot be reached for authorization. In the event the above-authorized refuse or are not able to act, Curtis Baptist School personnel are authorized to act as set forth above. This authorization may be presented to medical personnel to seek further authority.

    By placing your initials in this box, you are officially signing this form.