We the undersigned parents/guardians do hereby grant and give to the Mantachie First Baptist Church and/or its designated staff member and representative authority to treat or obtain emergency medical care for my child. This authority is granted only after a reasonable effort has been made to reach the emergency contacts listed above. Whether an emergency exists or not or whether medical care is needed or not is left to the sole discretion of the church and its designated representative authority to approve any necessary medical treatment that is determined to be needed for my child either by hospital emergency room staff or physician. We the undersigned parent or guardian assumes the responsibility for any costs connected with the treatment authorized above and hereby release First Baptist Church of Mantachie from any liability for the treatment. This authorization is extended for all First Baptist Church of Mantachie activities, and will remain in effect until the undersigned parent or guardian revokes the authorization in writing. *
Parent Signature: Please type your name and the date in the space below. Entering and dating this information will serve as your electronic signature.