By submitting this form, I, the parents/guardians, of listed student below, entrust said minors into the care of the Leadership Team of The Fountain, Visalia, California for the particular reasons for a temporary period of time, and for the welfare of such minor children.
In such connection, we authorize them to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care to be rendered to such minors under the general or special supervision, and on the advice of a physician or surgeon licensed under the Medical Practice Act, or to consent to any x-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care to be rendered to such minors by a dentist licensed under the provisions of the Dental Practice Act. Whether on any occasion such consent is rendered to any such medical or dental attention, it is to be considered within the provisions and limitations, under the same kinds of circumstances, within the full discretion, and in the course of the same kind of responsible deliberations as we such minor's Parents would have to consider it. We do not hold The Fountain and its associated parties liable for any above mentioned medical or dental attention deemed necessary by First Christian Church and its Leadership Team.
I also give permission to the Leadership Team of The Fountain, Visalia, California to transport my child from The Fountain or other agreed upon meeting place to the agreed upon location(s) listed below. In case of emergency, I also authorize extension of said dates listed below, should transportation difficulties arise.