I/We the undersigned parent(s) or legal guardian(s) of child/children mentioned above do here by authorize any x-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment by any licensed physician or dentist and/or hospital service that may be rendered to said minor(s) under the general, specific, or special request of Religious Education Department staff. This consent will remain in effect from June 19th - June 23rd. I understand that every precaution will be taken to ensure my son(s)/daughter(s)/ward(s) safety. Should an accident occur, I will not hold the Church of St. Henry or the Diocese of Tulsa or its paid staff or volunteer staff responsible. Further, I understand that attempts will be made to immediately contact me should an accident occur, I understand that ambulance or emergency personnel will be requested if deemed necessary. Payment for metical/dental emergencies is the sole responsibility of the parent(s)/guardian(s).