To Whom It May Concern The undersigned does hereby give permission for our (my) child First Name Last Name to attend and participate in activities sponsored by Breath of Life Christian Center's Sports Department. Date We (I) authorize an adult, in whose care the minor has been entrusted, to consent to transportation to a hospital/medical facility, any X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agree(s) to pay all cost and expenses incurred in connection with such medical and dental services rendered to the aforementioned youth pursuant to this authorization.