Emergency Authorization- I hearby give permission to medical personnel selected by the participant's church sponsor/his designee or camp staff to order X-rays, routine tests,a nd treatment for myself. In the event of an emergency and neith my primary contact, nor secondary, can be reached, I hearby give permission to the physician selected by the authorized agent to hospitalize, secure proper treatment, order injections and/or anesthesia and/or surgery to myself as named above.
I further authorize the realese of the above medical informatyion to appropriate medical personnel and/or the health coverage insurence company. In addition, I have, and do hearby, release the church, its employees or agents from liability associated with participation in a church activity.
I understand that if I do not have medical insurence, I, as the parent ot guardian, will be responsib;e for any medical expenses in the event of a sickness and/or injury.
I understand that there are risks involved in taking place in recreation activities and other activities related to participation in youth functions.