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2017 Harvest Outreach Church Medical Release & Permission Form STATEMENT OF HEALTH Must be completed with authorization release statement signed (on back of form) Students Name PhoneEmailAddress GradeGenderAgeBirth

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6. Double-check all the information you have entered to ensure its accuracy and completeness.
7. If you are unsure about any question or section, seek assistance from a relevant authority or consult the instructions.
8. Sign and date the form where required, and make copies for your records if necessary.
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1. Anyone who is required by law to submit the particular form or document.
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4. Students applying for admission to educational institutions or financial aid.
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The individual or entity specified in the instructions is required to file must be completed with.

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