If not applicable, please put n/a.
Please list who you (the parent/legal guardian) authorize - other than yourself or spouse - to pick-up your child from United Youth.
In case of an emergency, United Youth Director, has the permission to administer the following medication to my child.
Please check the following medication that you approve for your child. Please type any specifications or notes in the "notes" section at the bottom.
In the event that all reasonable attempts to contact me have been unsuccessful, I give my consent to the administration to my child of any medical treatment deemed necessary by a licensed physician and the transfer of my child to any hospital reasonably accessible. I understand and agree that Calvary Baptist Church does not assume responsibilty for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment.