I hereby release Desert Cross Lutheran Church, its staff and sponsors from responsibility and liabililty for any illness or injury that the above named child may sustain during any activity. In the event of an emergency, I hereby authorize an adult leader of the activity, as agent for me, to consent to any X-ray examination, medical, dental, anesthetic, or surgical diagnosis, treatment, and hospital care advised and supervised by a licensed physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where the services are to be rendered, either at the physician's office or in the hospital. I understand the activity director will endeavor to reach us should the nature of the injury or illness warrant it. However, we will not hold any of the activity personnel responsible if efforts to contact me (us) are unseccessful.
*The information provided will be reviewed by the Parish Nurse and shared with adults having contact with this child. Please call the church at 480.730.8600 if you have questions.