*Please review the agreement below. You will be asked for a signature on the following screen.
I, the undersigned parent/guardian do hereby give permission for any Black Mountain Presbyterian Church chaperone or youth leader to administer basic first aid to my child and to take him/her to a hospital for medical treatment when I cannot be reached or when delay would be dangerous to my child’s health. I consent to any examination, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care that may be rendered to said minor, under the general specific instructions of the physician provided, or if unavailable, by an on-call physician at a hospital or clinic. It is understood that this consent is given in advance of any specific diagnosis or treatment and is given to encourage those persons who have temporary custody of my child, in my absence, and said physician to exercise their best judgment as to the requirements of such diagnosis or said medical treatment. Delivered to said persons entrusted with the care, custody and control of said minor child, this consent will remain effective until the 1st day of January of 2019. I understand that any and all medical expenses incurred are my responsibility and that there is no medical insurance coverage provided by Black Mountain Presbyterian Church.Further, as parent/guardian of the named above, I do hereby 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.