I, the undersigned parent of guardian of the above stated child, a minor, do hereby authorize for duly authorized employee, volunteer, or other representative of the Gethsemane Church of Christ, agent(s) for the undersigned, to 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 of specific supervision of, any licensed physician and surgeon or at a clinic, hospital or other medical facility.
It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but it is given to provide authority and power on the part of the aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician is the exercise of his or her best judgement may deem advisable.
I, the undersigned, on behalf of myself and the above mentioned student, shall indemnify, hold free, and harmless, assume liability for and defend Gethsemane Church of Christ, its agents, servants, employees, officers, and directors from any and all costs expenses, including but not limited to attorneys' fees, reasonable investigative and discovert costs, court costs, and all other sums, which Gethsemane Church of Christ, it's agents, servants, employees, officers, and demand for, claim or assertion or liability, or any claim or action founded therein, arising or alleged to have arisen out of my child's use of real or personal property belonging to Gethsemane Church of Christ, it's agents, servants, employees, officers, and directors, or by reason of my child's participation in any Gethsemane Church of Christ activities.