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Medical Release Form

1General Release/Hold Harmless Agreement
2Student Ministry Medical Release
  • The undersigned or a member of the immediate family of the undersigned desires to participate in various programs, events, or activities (herein collectively referred to as "Activities") operated or sponsored by Journey Christian Church. The undersigned or a member of the immediate family of the undersigned further understands and acknowledges that the undersigned or a member of the immediate family of the undersigned may incur injury or bodily damage while participating in such Activities.

    The undersigned or a member of the immediate family of the undersigned further understands and acknowledges that Journey Christian Church will not allow the undersigned or a member of the immediate family of the undersigned to participate in such Activities without releasing and holding harmless Journey Christian Church.

    Further, the undersigned or a member of the immediate family of the undersigned requests Journey Christian Church to allow them to participate in activities and in consideration thereof agree to hereby release and forever discharge Journey Christian Church, their officers and their directors and their employees, their agents and any parties volunteering on behalf of Journey Christian Church, from all actions, claims, costs, expenses or damages of any kind growing out of or related to any activity of Journey Christian Church in which the undersigned or a member of the immediate family of the undersigned participates.

    The undersigned or a member of the immediate family of the undersigned further acknowledges that this is a full and complete release for all injuries and damages which the undersigned or a member of the immediate family of the undersigned may sustain as a result of the undersigned or a member of the immediate family of the undersigned's participation in any Journey Christian Church program.

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  • I, THE UNDERSIGNED, being the legal guardian of STUDENT/PARTICIPANT NAMED ABOVE, give my permission for him/her to attend Activities under the direction of Journey Christian Church. The undersigned, being a parent and/or legal guardian of the above minor, does hereby authorize the treatment of the above minor by a qualified and licensed medical doctor in the event of a medical emergency, which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment or undue discomfort if delayed, while said minor is participating in the above event, including transportation to and from the event site. This authority is granted only after a reasonable attempt has been made to contact me.
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Sundays @ 9:15 am
Journey Christian Church
3700 Price Club Blvd.
Midlothian, VA 23112
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