MEDICAL RELEASE FORM

Fill out our online form below

By submitting this online medical release form, you are giving permission to the church-appointed leader who is with your child to obtain medical assistance for them if needed. You are also giving permission to the Physician selected to hospitalize and secure proper treatment for your child.

Fields marked with an * are required

If you do not receive a successful submission message after clicking "Submit," make sure all required fields are filled in.