2016-2017 First United Presbyterian Church Permission Slip

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I give permission to the Youth Director and or youth sponsors to authorize emergency medical treatment for/
our son or daughter on any youth ministry sponsored event during the 2016-2017 school year. I understand
that I will be promptly notified in the event of any serious illness or accident and prior to any major surgery,
except when delay in such communication would endanger life.

In case of medical emergency, I understand that every effort will be made to contact the parents or guardians
of the participant. In the event that I/we cannot be reached, I hereby give permission to the physician selected
by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if
deemed necessary. Below are any special instructions or information that would be pertinent in case of a medical
emergency.