MEDICAL RELEASE: In the event of an emergency, I as a parent/guardian of the above-named child, give permission to the physician/hospital selected by SRBC leaders to consent for any x-ray, medical, dental, examination, anesthetic, release of insurance records; medical or surgical treatment, and hospital care which is advised and supervised by a licensed physician, surgeon, or dentist for my child. which, in the doctor’s opinion, may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed for the above-named child at parent’s expense. I authorize an adult youth leader of SRBC’s youth group, authority to act as agent for me, on behalf of my above-named child to; provide or arrange necessary related transportation, including paramedics, and ambulance transport. This authority is granted only after a reasonable effort has been made to contact me or my emergency contact. I hereby agree to fully pay all costs of medical or dental care connected with this treatment, and/or incurred by SRBC or their agent. I hereby release Spinning Road Baptist Church, Pastor, volunteers, agents, and vehicle driver of any vehicle driven (if transportation is part of an event) from liability. This release form is completed and signed of my own Free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.