I do hereby state that I have legal custody of this/these child/children, a minor, who resides with me. While this minor is a registered camper at any Illinois Assemblies of God PK Retreat Activity, I hereby authorize any director, counselor, nurse, dean, lifeguard, or other responsible person of said Retreat to consent to any x-ray, examination, anesthetic, medical, or surgical treatment, and hospital care, to be rendered to this minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice in the United States, when such medical or surgical treatment is necessary. I also give my permission for my child/children to receive over-the-counter medication from the retreat nurse if necessary.I give full permission to Illinois Assemblies of God PK retreat staff to reproduce any photograph and/or video image of me/my student(s) for promotional usage without obligation to me/my student(s). I have read the rules and agree to abide by them and do hereby give permission for my student(s) to participate in all PK Retreat activities.