Liability Release and Authorization of Consent for Medical Treatment of Minor Child
In the event that a serious accident or illness befalls your child, Westside: A Jesus Church (A Jesus Church Family) will first make every effort to contact you at home or place of business to comply with your instructions. If you cannot be located, Westside: A Jesus Church is authorized to:
1. Contact the family physician or alternative names listed above and follow their instructions.
2. Transport the above child to a local hospital for treatment by emergency room physician on duty.
3. The undersigned hereby authorizes the physician named to give consent for any procedure or hospital care deemed advisable by said doctor. In the event that the doctor is not available, Westside’s leadership is authorized to give necessary consent for any treatment, care, diagnosis, and/or examination of the person named.
I hereby release Westside: A Jesus Church (A Jesus Church Family), its’ employees and agents from all liability whatsoever for any injury, damage, or loss which may be sustained by my child during the course of involvement with Westside: A Jesus Church.