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United Methodist Church 501 Hampton Lane (Beltway Exit 27B & Dulaney Valley Road) email: towsonumc@towsonumc.org Towson, Maryland 21286 410-823-6511 Elevator is available to access all 3 floors! .
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APPENDIX H
POLICY OF THE TOWSON UNITED METHODIST CHURCH FOR THE PREVENTION OF ABUSE OF CHILDREN AND YOUTH
PARENTAL RELEASE AND MEDICAL FORM (GENERAL) The Towson United Methodist Church
In connection with any activities or events in which , my child (or ward), participates that are held, supervised, conducted, or sponsored by The Towson United Methodist Church (TUMC), I hereby waive, satisfy, release, and forever discharge TUMC and its affiliates, its officers, directors, trustees, employees, volunteers, servants, agents, and successors, and assign from and against any and all claims, demands, costs, expenses, liabilities, judgments, sums of money, actions, and causes of action of whatever kind and nature including, without limitation, those predicated upon negligence. This is intended to be a general release and waiver including, but not limited to, all claims for property damage, personal injury and any and all other damages of any kind or nature.
I further authorize any adult representative of TUMC to approve any medical treatment that might be required during any such activity or event.
_______________________________________________________________________ Signature of Parent or Guardian Date
Please list any known allergies and preexisting medical conditions: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________
Medical Insurance Information ___________________________________________________________________________________________ Company Policy #
Emergency Phone Numbers Parent/Guardian’s Name_______________________________ Phone __________________________________ Beeper ____________________________________________ Cell Phone _______________________________
Other Emergency Contacts Name ______________________________________________ Phone __________________________________ Beeper ___________________________________________ Cell Phone _______________________________
The Towson United Methodist Church 501 Hampton Lane, Towson, MD 21286 Phone: 410-823-6511 Fax: 410-823-8916 |
