Medical Release

I, the participant listed, wish to participate in Johnson University Florida special events. I understand that all participants are expected to abide by the event rules, and will be directly responsible to the Event Director.

Johnson University Florida’s Event Director assumes responsibility for discipline at the event, and if necessary, may require a participant to leave because of misconduct or disobedience.

I release, and hereby agree, to hold blameless Johnson University Florida and its employees and agents from any and all claims arising, or which may be asserted by me, or by any member of my family by reason of participating in any activities associated with Johnson University Florida. Further, I release my sponsoring church from the same liability.

I authorize the minister or sponsor of this activity or any Johnson University Florida staff member, in the event my emergency contact cannot be reached by phone, to give consent to a physician and or hospital for emergency medical or surgical treatment while on this trip. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment.

I certify that I am covered by adequate insurance. My consent and signature is given below. I have read and agree to the information given in this entire form.

First, Last, MI

PERSON TO NOTIFY IN THE EVENT OF AN EMERGENCY:

I certify that I am covered by adequate insurance.  My consent and signature is given below.  I have read and agree to the information given in this entire form.

(If participant is under the age of 18)