The above listed student has permission to attend and participate in activities sponsored by Valley Creek Baptist Church.
I authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or hospital. The undersigned shall be liable and aggress to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to his authorizatioin. Should it be necessary for my child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs. The undersigned does also hereby give permission for my child to ride on Valley Creek Baptist Church transportation.
Typing your name below is the same as signing this form.