St. Cross Episcopal Church Medical & Photo Release Form for VBS

Parental Consent and Medical Release Form St. Cross Episcopal Church – Vacation Bible School. I, the undersigned parent or legal guardian of the minor child named below, hereby grant permission for my child to participate in the Vacation Bible School program at St. Cross Episcopal Church. I understand that all reasonable precautions will be taken to ensure the safety and well-being of my child. I voluntarily waive any claim against St. Cross Episcopal Church, its clergy, staff, volunteers, and authorized leaders or sponsors for any liability, loss, or injury incurred during this program. In the event of a medical emergency, I authorize and consent to any necessary x-rays, anesthesia, medical or surgical diagnosis or treatment, and hospital care deemed advisable and administered under the supervision of licensed medical personnel and/or hospital staff. This authorization is granted in advance of any specific diagnosis or treatment and is intended to permit medical care in the event of an emergency, as determined by the attending physician’s best judgment. I waive any claim against the church and its approved leaders or sponsors. In case of medical emergency, I hereby authorize and 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 special supervision of any licensed medical personnel on the staff of any licensed hospital. This authorization is given in advance of any specific diagnosis, treatment or hospital care required, but is given to provide authority and power to render care which is deemed advisable in the best judgment of the physician.

General Guidelines: It is recommended that a release be obtained when photographing or videotaping a minor (under 18). Parent or guardian signatures are required; signatures of minors are not sufficient. When images are published, St. Cross will take cautionary steps to provide minimum identifying information and will not use specific street or mailing addresses, email addresses, or phone numbers. If you have questions, please contact St. Cross at 310-376-8989.