RELEASE FROM LIABILITY
I am the parent or legal guardian of the student listed above and consent to my student's participation in the activities that are a part of the events relating to Summer Splash, which are affiliated with Crossroads Bible Church of Bellevue, WA. I HEREBY RELEASE Crossroads Bible Church and any of its affiliates, officers, directors and agents from any and all civil liability.
This authorization and release shall remain in effect for the duration of the foresaid activities, unless sooner revoked in writing and delivered to said agent(s) associated with the aforesaid activities. The dates of the duration for the aforesaid activities are April 10 - July 13, 2019.
AUTHORIZATION TO PROVIDE TREATMENT
I, the undersigned, do hereby authorize Crossroads Bible Church of Bellevue as agent(s) for the undersigned to consent to any x-ray examinations, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the PHYSICIANS AND SURGEONS ACT and on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.
It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforesaid physician, in the exercise of his best judgement may deem necessary and advisable.
This authorization is to remain in effect until July 13, 2019 or rescinded in writing.