I (we), the parents/guardians of the aforementioned student, do give permission for him/her to participate in activities of Ustick Baptist Church (UBC). I (we) also authorize UBC as agents for the undersigned to consent to any necessary medical attention for our child, such as x-ray examination, anesthetic, medical or surgical treatment, and hospital care, which is deemed advisable by a licensed physician/surgeon.

In the event treatment is required from a physician and/or hospital personnel designated by the Church, I (we) agree to hold such person(s) from UBC (i.e. staff and volunteers) free and harmless of any claims, demands, or suits for damages arising from the giving of the consent. I (we) also acknowledge that I (we) will be ultimately responsible for the cost of all medical treatment incurred and responsible for all transportation expenses.

I (we), the undersigned, have read and understand all of the above and have given true and accurate information.