I, the undersigned, hereby declare and affirm that:

I am the parent/legal guardian of the youth named above (hereinafter referred to as "Child"), who is under my care and responsibility.

I hereby consent and give authority to the participation of my Child in the scheduled youth activities of the organization , and all other activities which is supervised and customarily associated with its youth group.

I hereby declare and affirm that my Child is physically fit to take part in the organization  activities and my Child has no known illness or adverse medical condition that would render him/her unfit to participate therein, other than the information specified in the medical information above.

I shall immediately advise the organization  in writing, should I discover any illness, adverse medical condition, or any other physical defect that would render my Child unfit to participate in the recreational and sporting activities of the organization.

I shall notify the organization immediately in case I revoke my consent to the organization for this event.

Authorization for Medical Treatment

I understand that in case of medical emergencies involving my Child, I shall be notified right away. In case any of my provided contact information is unreachable, I authorize the organization to call the doctor indicated above. In case that the doctor is not available, I authorize the organization to call any doctor to provide the necessary medical attention to my child.

I understand that the organization shall not be responsible, and shall be reimbursed, for any medical expenses incurred by them over this authorization.