I, the undersigned parent or guardian, do hereby authorize emergency medical, dental, health or hospital services be rendered to my child upon consent of a Peace Lutheran Church staff member or designated volunteer. The purpose of this authorization is to permit my child to receive emergency medical attention when needed while involved in the activities connected with Peace Lutheran Church’s Education Ministry programs when I or my emergency contact is unavailable to give such consent. This authorization shall be effective from September 1st, 2021 until August 31st, 2022. *
Parent/Guardian First and Last Name