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As a parent or guardian, I do herewith authorize treatment under the direction of any licensed physician to the above minors, in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. The authority is granted only after a reasonable effort has been made to reach me by phone at the numbers listed above.
The undersigned assumes the responsibility of any costs connected with such treatment and hereby releases Harvest Bible Chapel Windsor Inc., where the child attends Harvest Kids Club, from liability.
Photo/Video Release & Consent:
I hereby grant permission to Harvest Bible Chapel Windsor to use images and video of the above named child(ren) on its web site or other church social media platforms or publications without further consideration. I understand that no names will be used online or in publications unless specific written permission is given to an appropriate staff member. I understand that once any image is posted to Harvest’s web site the image can be downloaded by any computer user around the world. I hereby attest that I am the legal parent or guardian of the child(ren) listed above. This consent is effective until such time as I revoke it in writing
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