Beruflich Dokumente
Kultur Dokumente
c
Joyful Noise Home School Band and Choir
release authorization & medical form
Musician Information:
Name________________________ Age __________
Birthday______________________
Emergency Contact Info______________________________________
Medical Considerations (allergies or conditions)_____________________
________________________________________________________
Doctor·s Office Contact Info___________________________________
Family Information:
Parents Names______________________________________________
Address__________________________________________________
Daytime phone number________________________________________
Evening phone number________________________________________
Email address______________________________________________
_________________________________________________________
Parent or guardian name (please print)
_________________________________________________________
Parent or guardian signature date
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The parent/legal guardian further understands that the Christison family will make
reasonable efforts to notify the parent/legal guardian or another parent of the
musician in the case of an accident, sudden illness or other condition, but
authorizes the Christison family or music group affiliated adult to seek such care
or treatment, and for any care or treatment to be administered, even in
the event that either parent or legal guardian are not contacted prior to the
seeking or rendering of such, care, treatment, or other measures.
The parent/legal guardian signing this form releases the Christison Family and any
music group affiliated adult from and of any liability for such decisions or actions in
seeking medical care, and agrees to pay all the costs and fees for the medical care
or treatment authorized under this Emergency Medical Authorization.
Liability Waiver
The parent/legal guardian agrees to hold harmless the Christison Family, adults
affiliated with the music group, and the owners of any properties made available
for music group activities, from any claims, damages, losses and/or expenses arising
out of participation in music activities and to assume all liability for any and
all personal injury, bodily injury, illness or property damage that occurs as a result
of participation in such music activities. The parent/legal guardian also warrants
that participation in this activity is voluntary and that the musician and
the parent/legal guardian understand the inherent risks involved in music activities,
and the musician agrees to obey all rules and policies mandated by Skyla Christison
and adults affiliated with the music group.
_________________________________________________________
Parent or guardian name (please print)
_________________________________________________________
Parent or guardian signature date