I, the undersigned parent or guardian, hereby consents to my child participating in VBS sponsored by FBCEFR. If my child has medical conditions which may be relevant to this program, I have listed them above. If I cannot be reached, I hereby authorize any adult connected with the program involved, including any physician and/or hospital, to implement any reasonable medical care, including surgery, deemed necessary for the welfare of my child. If there are any activities I do not want my child to participate, I have listed them above. I also release and agree to hold harmless FBCEFR as well as it’s members, and everyone else connected with the described program from any and all claims, cause of action, and the like, arising out of injury to my child, including death, which I or my child, or his/her heirs and assigns, may have in connection with the program involved. I have carefully read this document and understand its contents. Furthermore, the information that I have provided, as set forth hereon, it is accurate as far as I know. The within document shall be binding upon me, and upon my child’s heirs, beneficiaries.