do hereby authorize adult workers with the student ministry of Grace Community Church, Inc. to consent on my behalf for the aforementioned student, to any 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 at said hospital.
Further, as parent or guardian of the child named above, I do hereby expressly consent that my child may receive emergency medical treatment from any physician, hospital, or other medical center without the necessity of first notifying me, and do further agree to hold blameless any physician, hospital, or other medical center for rendering such services.
Further, as parent or guardian of the child named above, I do hereby consent to adult workers with the student ministry at Grace Community Church, Inc. to provide first aid treatment and/or provide over-the-counter medication as they deem necessary, and do further agree to hold blameless Grace Community Church, Inc. and adult workers with the student ministry for rendering such services.
Further, as parent or guardian of the child named above, I do hereby consent to adult workers with the student ministry to provide transportation for my child during activities, and do further agree to hold blameless Grace Community Church, Inc. and adult workers with the student ministry for rendering such services.
By signing this waiver, I release Grace Community Church, Inc. from liability on my student regarding any and all official Grace Community Church, Inc. sponsored activities for the year 2019.