I hereby give my permission to the medical personnel selected by the church leader, guide or driver to order X-rays, routine tests, and treatment for my youth, in the event I cannot be reached in an emergency. I hereby give my permission to the physician selected by the church leader, guide or drive to hospitalize, secure proper treatment for, and to order injection and/or anesthesia, and/or surgery for my child as named above. I am responsible for any medical obligations incurred during the above-named event.