I, the above-named, being the parent or legal guardian of the child named above, do hereby consent to the participation of my child in all activities conducted by Bethlehem Lutheran Church. I certify that my child is physically fit and adequately prepared to participate in this event.

Medical Treatment Authorization: I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event that my child is injured or becomes ill.

I authorize a Bethlehem staff member or another adult chaperon designated by the staff to make emergency medical care decisions on behalf of my child if required by law or a health care provider. I authorize these persons to act in my place to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, and hospital care. If my child has life-threatening allergies medical staff should be aware of, I have indicated this in the above space provided. 

I understand that Bethlehem Lutheran Church or any authorized chaperone will not be responsible for medical expenses incurred solely on the basis of this authorization. I also understand that the designated adult chaperones reserve the right to restrict my child from any activity that they do not feel is within the physical capabilities of my child.

If transportation is necessary, my child will be transported by a background-checked, church-approved driver.