In the event that my son/daughter requires special medical treatment during his/her participation in activities related to Rowandale Youth, including transportation to and from the activities, I the parent/guardian will be notified immediately.

If all reasonable attempts to contact me have been unsuccessful, I hereby consent and give my permission to the physician(s) and any other medical personnel selected by the youth pastor, adult youth leaders or volunteers of Rowandale Baptist Church to hospitalize, secure proper medical treatment for, and/or to order x-ray examination, injection, anesthetic, surgery or dental diagnosis for my child as named above which may in their safe discretion be necessary.

I hereby warrant that to the best of my knowledge, my son/daughter is in good health and I assume all responsibility for the health of my child. I agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned youth pursuant to this authorization.