I the undersigned First Name* Last Name* ,am the parent or legal guardian of the child/children named above. As parent or legal guardian I give consent for my child/children named above to attend 'OUTBACK ROCK' VBS at Pembroke Pentecostal Tabernacle, Pembroke, Ontario. As parent or legal guardian , I hereby voluntarily release, forever discharge the community, the corporation, it's officers, directors, employees, volunteer and agents of Pembroke Pentecostal Tabernacle from any and all claims, demands, or causes of action, which are connected with my child's participation in the program or the use of equipment and facilities. I (We) understand in the event medical treatment is required, every effort will be made to contact me, however, if i cannot be reached, I give permission to a licenced medical practitioner to provide the necessary care, including anesthesia, for my child/children's well being. by signing this form on, Date* , I confirm that I have fully informed myself of the contents of this Parental Consent and Release form by reading it before I signed it. I warrant that I possess all the rights, powers and privileges of a parent or legal guardian necessary to execute this document with binding legal effect. Signature*