I give permission for my child to participate in all Youth Center supervised activities. I hereby release The Factory Ministries from the responsibility of any liability involving injury or accident to my child participating in Youth Center related activities. I, as the parent or guardian of the participant(s) listed above, will accept full responsibility for my child’s actions.
I hereby request and authorize the Factory Ministries Youth Center staff and volunteers, hospitals, licensed medical or dental providers, and their agents and employees to have access to the information on file for my child and to provide all medical or dental care, routine tests, treatment, and necessary transportation advisable for the health and safety of my child. This authorization includes the authority to consent to any x-ray examinations, anesthetic, medical procedure or treatment, and hospital care under the supervision, and upon the advice of or to be rendered by, a physician or surgeon licensed under the Medical Practice Act or dentist licensed under the Dental Practice Act for my child. To the best of my knowledge, I have listed above all of my student’s medical allergies, medications being taken, medical problems and other pertinent information.