I hereby release Fourth Presbyterian Church, its staff, and adult representatives from responsibility and liability for any injury or illness that my child may sustain during an event. In the event of an emergency. I hereby authorize an adult leader of this activity. as agent for me, to consent to any X-ray examination, medical, dental, or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where services are rendered, either at a doctor's office or in any hospital. I expect to be contacted as soon as possible.