Authorization to Consent to Treatment of a Minor and Release from Liability, and Photographic Release Vacation Bible Camp, July 19-22, 2010

I, , the parent (legal guardian) of the child (minor) listed on this registration form, understand that in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I do hereby authorize Overlake Christian Church as an agent(s) for the undersigned to consent to an x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the PHYSICIANS AND SURGEONS ACT and on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of our aforesaid agent, to give specific consent to any and all such diagnosis, treatment or hospital care which aforesaid physi-cian in the exercise of his best judgment may deem advisable.

I have read the above and consent to my child participating in the activities of the listed event. I also understand that my child is under the authority of the church leadership and that failure to comply with leadership could result in dismissing my child from this event and my being called to come pick him/her up.

I also hereby grant permission to Overlake Christian Church (Redmond, Washington) to use photographic images containing photograph/likeness of said minor for various purposes such as printed material, publications, displays, video productions, PowerPoint presentations, etc., as well as the various Overlake-related sites on the World Wide Web (WWW). I also acknowledge Overlake's right to crop or treat the photographic image at its discretion.