Minor Consent and Medical Forms

MM
/
DD
/
YYYY

Emergency Contact (Parent/Guardian)

Second Emergency Contact (Parent/Guardian)

Medical Authorization and Release

I understand that FBS will make reasonable efforts to contact Participant’s above listed Emergency Contacts in the event of a medical emergency. Nevertheless, I hereby give permission and authorize the applicable staff, volunteers, and agents of FBS to provide, facilitate, and consent to the provision of any first aid, doctor’s care, hospitalization, surgery, transportation to medical facility, and/or any other form of medical care or treatment that they deem necessary because of illness, injury, or other health problems that Participant may suffer while participating in the Activities. I agree to be financially responsible for any medical bills incurred as a result of medical treatment for Participant. I agree to release and hold harmless FBS and its employees, volunteers, directors, officers, other agents, and any agencies it works in conjunction with, from any claims, liabilities, actions, demands, or losses for or from bodily injury, property damage, or otherwise, which may arise from provision or omission of any type of medical care or transportation to or from a treatment facility by those chosen by FBS to administer medical care for and/or transport Participant, and which may arise by any cause, including through the negligence or carelessness of FBS, its agents, or any agencies working in conjunction with them. I understand that all reasonable safety precautions will be taken at all times by FBS and its representatives during the Activities.

Medical Information

MM
/
DD
/
YYYY
I acknowledge that FBS may offer me an optional insurance policy and that, if offered, such optional policy is the only medical insurance coverage available (outside of my own medical insurance coverage) for any accidents that occur while participating in the Activities. If offered, this policy is available for a fee in addition to those fees already associated with the Activities.
MM
/
DD
/
YYYY
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20