Fountain Youth Emergency Contact and Medical Information Form

This form must be updated for all 7th - 12th graders each calendar year.

We seek to ensure the safety of all pre-teens and teens in our care. Forms like these help us do that. After filling out the information below, please electronically sign stating that you authorize all medical and surgical treatment, X-ray, laboratory, anesthesia and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for below listed child and waive your rights to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in case of emergency. This also states that you release First Christian Church and individuals from liability in case of accident during activities related to First Christian Church (or eNLiveN Student Ministries), as long as normal safety procedures have been taken.