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Complete the form along with the medical release information (if not already on file with GBPC).
By submitting this form, parental/guardian permission is granted.
In case of an emergency, I understand that Great Bridge Presbyterian Church, through the designated person in charge, will first attempt to notify me or the alternate emergency contact listed. In the event we cannot be reached, I hereby grant permission to the physician or hospital selected by Great Bridge Presbyterian Church, or the person in charge, to provide medical treatment (examination, diagnosis, x-ray, treatment, anesthetic, etc.) for my child as deemed necessary and rendered by or under the general or special supervision of any licensed physician or medical staff of a licensed hospital. It is further understood that the undersigned will assume full financial responsibility for all expenses incurred for any of the foregoing services. This authorization is given in advance of any required care to empower the agent to give consent for such treatment as the physician may deem advisable.