I, the undersigned parent or guardian of the student I am registering, do hereby authorize NC West Youth district leadership to consent to any emergency examination, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care which is rendered under supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or said hospital. Further, as parent or guardian of the student named below, I do consent that my student may receive an emergency medical treatment from any physician, hospital, or other medical center with necessity of first attempting to notify me, the emergency contact, and the youth pastor, and do further agree to hold blameless any physician, hospital or other medical center for rendering such service in the case that the aforementioned contacts cannot be reached. In addition, I will hold blameless North Carolina West district, Victory Mountain Camp or its leaders and other staff involved.
I also agree (at my own expense) to pick up my child early from camp should any health issue arise.