Please include any medications being taken
Please include any medications being taken
Please include any medications being taken
Please include any medications being taken
Emergency Release
By their signature(s) below, the parents/guardians of the Visiting Student hereby acknowledge and give consent for their child to spend the above-referenced school day at MCCS for the purpose of experiencing a typical school day at MCCS. The Visiting Student will participate in all classes and activities of their host student which may include physical education class, recess, lunch, etc. The Visiting Student will abide by all MCCS policies regarding behavior, dress code, etc. Pre-notification will be given to any/all affected staff members so that arrangements can be made for the Visiting Student to be accommodated. This release agreement does not apply to claims of intentional criminal misconduct or gross negligence by the school, its employees, or volunteers. If intentional or negligent conduct is proven in a court of law, I acknowledge and agree that I will hold harmless Mount Calvary Church and Mount Calvary Christian School, and all of its affiliated organizations, for any judgment or financial liability beyond the actual amount of liability insurance in force at the time of the occurrence.
Consent
If the school cannot reach these persons or other parent or guardian after conscientious effort, I give permission
for school staff to call paramedics or any other health care provider. If a life-threatening emergency exists, I give
permission for school staff to call paramedics immediately and then contact the person above as soon as possible
thereafter. By the signing of this form, I authorize and consent to any X-ray examination, anesthetic, medical,
dental, or surgical diagnosis or treatment and hospital care which in the best judgment of the health care provider
is deemed advisable. I agree to assume the financial responsibility for expenses incurred as a result or those
services being provided. I also agree to be financially responsible for emergency medical transportation and all
other costs related or associated with medical treatment.
By signing below, I acknowledge that I have read and understand the rights and responsibilities described in this
form. I further acknowledge that I agree to the terms listed above and that I intend to be legally bound by the term