By agreeing to this form and signing below, I, as the parent or legal guardian of the child listed above, do hereby consent to any medical care and the administration of anesthesia determined by a physician to be necessary for the welfare of my child while said child is under the care of Table Rock Fellowship staff and volunteer members of Medford, Oregon and I am not reasonably available by telephone to give consent.
I agree that this authorization is effective from January 2022 until December 2022.