First Anna Church Inc., a Texas non-profit corporation, is designated by the abbreviation “FAC” throughout this entire form.

I (we) hereby authorize First Anna Church to take my (our) child the before named physician or facility for medical treatment in the event of an emergency in which neither parent can be reached.

I (we) hereby give permission for my (our) child to attend & participate in activities sponsored by First Anna Church.

I (we) hereby authorize First Anna Church to transport my (our) child to or from church activities.

I (we) hereby authorize First Anna Church and its acting leaders to teach and lead my (our) child in religious lessons and services, which may include prayer and Bible teaching.

I authorize any responsible adult caring for my child to consent to any necessary medical, dental, or hospital treatment, including x-rays, anesthesia, and surgery, as advised by a licensed physician or dentist. This permission applies whether care is provided at a doctor’s office, dental office, or hospital.

The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to their authorization.

I agree to release and hold harmless FAC, its affiliates, and representatives from any claims, expenses, or liabilities arising from my child’s participation in this trip or event, including any bodily injury, property damage, or other incidents that may occur. This release applies to all potential claims resulting from the actions or negligence of FAC, other participants, or third parties during the trip. I assume all risks involved on behalf of my child.

Further authorization and permission is hereby giving to said church to furnish any necessary transportation, food and lodging for this participant.

I (we) understand photos and videos of my child may be taken for use in FAC publications. I also understand publication of these photographs may be accomplished electronically via the Internet/World Wide Web and that the after publication; FAC will be unable to prevent persons from gaining access to the internet/world wide web, copying my photographs and video there from, and subsequently using, altering or republishing them without my consent.

I (we) waive any claim for damages against FAC from unconsented-to use, alteration or republication of my photographs and video by third parties accessing the internet/world wide web.