Permission Release and Medical Authorization Permission Release and Medical Authorization Student Information*Student NameDate of BirthSchool Father/Guardian Name* First Last Phone*Email* Mother/Guardian Name* First Last Phone*Email* Permission Release & Medical AuthorizationMy son/daughter has permission to attend and participate fully in Zion Lutheran Church Sunday School Activities. I hereby authorize the Church staff or sponsor(s) to obtain whatever medical service/treatment is appropriate and suitable to protect the health and welfare of my child (including emergency surgery) and agree to assume full responsibility for payment of any and all medical bills incurred as a result of this authorization. I understand I assume all risk of personal injury, sickness, death and expense as a result of my child participating in this program. I hereby release, forever discharge and agree to hold harmless Zion Lutheran Church in Loveland, CO and its directors from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses of any nature whatsoever which may be incurred by my son/daughter that occur while the child participating is participating in our program. I further agree to indemnify and hold harmless Zion Lutheran Church, its directors, employees and agents for any liability sustained by said church as the result of the negligent, willful or intentional acts of my son/daughter, including expenses incurred attendant thereto and reasonable attorney fees. Signature*Date* Date Format: MM slash DD slash YYYY Medical InformationIf filling this form for multiple students, please clearly indicate the name of the student for each medication, allergy, and dietary concern.Medication(s)Allergies/Health ConcernsSpecial Diet ConcernsOther This iframe contains the logic required to handle Ajax powered Gravity Forms.