PLEASE READ THIS MEDICAL RELEASE CAREFULLY

BY REGISTERING BELOW YOU ARE CONSENTING TO ITS TERMS

We, the parents/guardians of the child (children) being registered below request that he/she/they remain under the care and supervision of Laguna Niguel Presbyterian Church Children’s Ministries from June 2018 to June 2019.

Should the need arise or be perceived, we authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any member of the medical staff and emergency room staff licensed under the prohibition of the Medical Practice Act or a dentist licensed under the provision of the Dental Practice Act and on the staff of any acute general hospital holding a current license under the laws of the state of California.

It is understood that this authorization is given to provide authority and power to render care which the aforementioned physician in the exercise of his/her best judgment may deem advisable. It is understood that every effort shall be made to contact you prior to the rendering of treatment, but that any of the above treatments will not be withheld if the undersigned cannot be reached.

We will not hold Laguna Niguel Presbyterian Church, its members, parent supervisors, chaperones or any affiliated organization liable for medical aid rendered, and will reimburse him/her for medical or other expenses incurred in the care of our child.

THIS AUTHORIZATlON IS GIVEN PURSUANT TO SECTION 25.8 OF THE CIVIL CODE OF
CALIFORNIA AND REMAINS EFFECTIVE ONLY FOR THE DATES LISTED ABOVE.


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