Medical Release Form

School Year 26/27

Please fill out one Medical Release form per child enrolling in AFLC. All other forms are one per family.

(I) (We), the (Parent(s)), (Guardians) of the child(ren) listed on this form, do hereby authorize the sponsor representing Anchored Family Learning Center (AFLC), whose classes meet in Ridgefield, WA in order that (my) (our) child(ren) may receive the proper medical treatment in the event that he/she may sustain injury or illness during the period of registered events. (I) (We) hereby authorize the staff to obtain or provide medical treatment for (my) (our) child (ren) for such injury or illness during the event, and (I) (We) hereby hold that event staff and AFLC, as well as its representatives, harmless in the exercise of this authority. (II.) It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care required but is given to provide authority and power on the part of aforesaid agents to give specific consent to any and all diagnosis, treatment & hospital judgment deemed advisable. (III.) This is to be effective for the scheduled events unless revoked in writing by to said sponsor. (IV) It is understood that, as parent(s) or guardian(s), (I) (We) are responsible for all medical costs and (I) (We) will not hold AFLC or any officer, board member, volunteer, drivers, or tutors, liable for medical aid rendered to (my), (our) child (ren).