Medical Consent
I, (please print) ______________________________________, hereby grant permission for a member
of ______________________________ (Haunted House) to take whatever steps may be necessary to
obtain emergency medical care for the below named participant. These steps may include, but are not
limited to, the following:
• Attempt to contact a parent or guardian if the volunteer is a minor
• Attempt to contact the volunteer’s emergency contact listed on file
• A hospital or emergency service
In addition, you agree to not hold __________________________________________ (Haunted House)
responsible for any injuries, accidents, lost or stolen items, or any other ill effect suffered as a result of
your volunteering for the haunt.
Please list any health problems that we should know about (i.e. Diabetes, epilepsy, heart conditions,
allergies, back problems, etc.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________
Volunteer Signature (and Parent/Guardian Signature if volunteer is a minor)
_____________________________________________
Date
