Driftwood Student Ministry Parental Consent Form

To whom it may concern,

The undersigned parent or Legal Guardian, do hereby give permission for ___________________________
to attend and participate in activities sponsored Driftwood Christian Church during the years, 2015-2016. Overnight
events and activities outside of Indiana may require an additional consent form. Some events have their own liability
release forms that will still require completion before your student can attend.
We authorize an adult, in whose care the minor has been entrusted, to consent to an x-ray examination on, anesthetic,
medical, surgical, or dental diagnosis or treatment, emergency blood transfusions, and hospital care, to be rendered to the
minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions
of The Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at
the office of said physician or hospital.
The undersigned shall be liable and agree to pay all costs and expenses incurred in connection with such medical and
dental services rendered to the aforementioned child pursuant to this authorization. We consent for the aforementioned
child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while
attending/participating in activities sponsored by Driftwood Christian Church.
Parents/Guardian Name (BLOCK CAPITALS) _______________________________
Signature of Parent/Guardian _________________________________
Relationship: ________________________ Date: _________________________