MCPC Permission Slip & Medical Release 

MCPC Permission Slip & Medical Release Form
For Children & Youth, on-site & offsite activities

Child's name, Address, Grade, and Date of Birth

Please provide details for any additional children

I hereby grant permission for my child or children to participate in Monument Community Presbyterian events and trips during the year specified below. Should any problem arise concerning the behavior of my child(ren) that would require them to return home prior to the end of the activity, I will pay for his or her return or come and pick my child up.
I recognize that Monument Community Presbyterian (MCPC) uses photographs and video images of events in our publicity materials such as the church website, newspapers and newsletters and I hereby grant permission for the photo/video images of my child to be taken and used for such purposes.
The child and/or children listed below may be given acetaminophen, ibuprofen or Sudafed by the advisors as needed.
I authorize the treatment, by a qualified and licensed medical doctor, of the minor listed above in the event of any medical emergency which, in the opinion of the attending physician, is necessary and I/we cannot be reached after reasonable effort has been made to secure my personal consent.

Emergency & Medical Information Required

Emergency Contacts for Child

Special Medical Conditions

Allergies, chronic illness, or other condtions for each child:

Submit