I, hereby authorize any duly authorized employee, volunteer, or other representative of Grace Community Church, as agent(s) for the undersigned, to consent to any 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 specific supervision of, any licensed physician and/or surgeon, or at a clinic, hospital, or other medical facility. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but given to provide authority and power on part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his or her best judgment may deem advisable. Furthermore, I knowingly release, absolve, indemnify, and hold harmless Grace Community Church, its members, employees, volunteers, and/or other representatives, from all claims that might result from any injury and/or death of said child.
I hereby grant permissions for my child's photograph to be included in the church's newsletters, slide show, local press, outreach brochure and the church website.