Lindell Study Center
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College & Young Professionals
The Lindell Expansion Project
2019 Summer Blast Medical Release Form
A separate Registration Form and Medical Release Form must be completed for each camper.
Indicates required field
Name of Child
Date of Birth
If no medications, type "none".
If no allergies, type "none".
Medical Conditions That May Affect Emergency Treatment
If none, type "NA"
Health Insurance Company
In connection with "Summer Blast 2019" taking place on June 11-13: In the event of injury, I authorize emergency treatment of my daughter by appropriate hospital, physicians, and other health care providers. I hereby release Lindell Study Center and its volunteers and staff from any and all liability in the event of injury. A copy of this release may be used in place of the original, if necessary.
Checking this box constitutes my electronic signature for the Parent/Guardian Statement above.
Checking this box will constitute your electronic signature.
Full Capacity for Summer Blast 2019 has been reached.
PLEASE HAVE PAYMENT INFO READY TO AVOID BEING LOGGED OUT WITH AN INCOMPLETE APPLICATION. THANK YOU.
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Opus Dei in the U.S.
ABOUT ST. JOSEMARIA ESCRIVA
St. Josemaria Escriva
Writings of Josemaria Escriva
(c) 2015. All Rights Reserved. Lindell Study Center, 700 West Essex Avenue, Kirkwood, MO 63122 Tel: 314-822-3627 Fax: 314-822-3747