Medical/Liability Release *
I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I cannot be reached in an emergency during the activity sponsored by FBC Albemarle, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment, and/or to order an injection, anesthesia, or surgery for my child as deemed necessary.
I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed.
I understand all reasonable safety precautions will be taken at all times by FBC Albemarle and its agents during the course of events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold FBC Albemarle, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.
I understand that by checking "Yes," I am agreeing to the above, and that by providing my initials/full name at the bottom of this form, I am agreeing to the above terms.