I/We, the undersigned parent(s) or guardian(s) of the above named child, a minor, do hereby authorize the teachers or staff of Red Hill Lutheran Church and School to act as agent(s) for the undersigned to consent to any x ray examination, anesthetic, medical or surgical diagnosis, treatment or hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon under the provisions of the Medicine Practice Act and any hospital whether such diagnosis and/or treatment is rendered at the office of a physician or at a hospital. This consent is also to extend to any dentist licensed under the Dental Practice Act.
It is understood that this authorization is given in advance of any specific diagnosis, treatment and/or hospital care being required, but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment, and/or hospital care which the physician/dentist, in the exercise of his/her best judgment, may deem advisable.
This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California and shall remain effective until August 31, 2023 unless sooner revoked IN WRITING, and delivered to said agent(s). It is understood that an effort shall be made to contact the undersigned prior to the rendering of treatment, but that such treatment will NOT be withheld if the undersigned cannot be reached. I will not hold Red Hill Lutheran Church & School, its teachers or staff, liable for medical aid rendered or consent given for diagnosis and/or treatment of my child.
I/We the undersigned parent(s) or guardian(s) of the above named child, a minor, does hereby consent to such minor child taking part in activities, with full understanding that insofar as such activities might involve physical activities and mingling with other individuals and groups, that there is always the risk of injury, illness and loss, and possible consequent expense for medical diagnostic and curative treatments and incidental loss and expense; and, in these premises the undersigned does hereby for himself/herself and for and on behalf of such minor assume the risk of such loss and expense, and does hereby wholly release Red Hill Lutheran Church & School from any responsibility or liability, and waives any claims, causes, or action against it or its agents that might arise on account of loss, injury, or expense occasioned by any sort of accident or other circumstance involving such child, and agrees to hold harmless Red Hill Lutheran Church & School, in any event that such claim should arise and the undersigned agrees to support the rules and regulations, supervision and discipline set by Red Hill Lutheran Church & School and its agents; and the undersigned holds harmless Red Hill Lutheran Church & School from any cause of action arising from that consent. The undersigned will furnish payment or insurance of any such expense.
