I, the undersigned parent/guardian, do hereby grant permission for my son or daughter, named below, to attend and participate in the activities of the event during the dates named above.
In the event I cannot be reached by phone, I authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff or a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.
The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my) child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs.
I also give permission for the staff to give my child over-the-counter medication.
The undersigned does also hereby give permission for our (my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by the Church.
I, as parent/guardian with legal responsibility for this child, do consent and agree to release StoneBridge Christian Church and it’s officers, employees, volunteers, officials and agents from any and all claims, liabilities, loss of service and causes of action of any kind for personal injury and property damage arising in any way out of my minor child’s involvement or participation in this program.