Medical Liability Release

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I consent and give the Crowley Seventh-day Adventist Church authority and permission to select a medical treatment facility, physician, and all necessary emergency medical care required in case of an accident, emergency, or illness for my minor child.

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Note: Every effort will be made to contact the parent/guardian in an emergency; however, I will hold the Crowley Seventh-day Adventist Church forever harmless for supervising all required emergency care. I will be responsible for all payments for all treatments, hospitalization, anesthesia, or surgery concerning emergency care for my minor child. I have read and understood this Medical Liability Release, fully understand its contents, and consent to conduct this transaction electronically. I attest that I have the authority to act on behalf of the minor child indicated herein. By checking the box below and by my electronic signature, I authorize the leaders of the Texas Conference to act on my medical behalf in case of emergency.