Gadgets & Gizmos VBS

June 19th - 23rd - 6:30pm-8:30pm

Ages: TK - 5th Grade 

Before you register your child you will need to complete the medical release form below.

 

Parent Name *
Parent Name
Child's Name *
Child's Name
Agreement to the Authorization For Medical Treatment *
By typing your name in the box below you agree that you have read and understood the Authorization For Medical Treatment.
Date *
Date

TFBC GADGETS & GIZMOS VBS - AUTHORIZATION FOR MEDICAL TREATMENT

My child is attending and participating in activities at Tulare First Baptist Gadgets & Gizmos VBS (hereinafter "VBS," located at: 469 N. Cherry Street in the City of Tulare, County of Tulare and State of California, beginning on the day of June 19, 2017 through June 23, 2017.

I hereby authorize the VBS Director and her officers, agents, servants, or employees that are 18 years of age or older, who supervise the activities at this VBS into whose care my child has been entrusted, to consent to medical care or dental care, or both, for my child under Sections 6901, 6902, and 6910 of the California Family Code.

The authority granted by this authorization includes the authority to consent to any x-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act for my child. This authority also extends to any x-ray examination, anesthetic, dental, or surgical diagnosis or treatment and hospital care by a dentist licensed under the Dental Practice Act for my child.

I further authorize the VBS Director and her officers, agents, servants, or employees that are 18 years of age or older, who supervise the activities at this VBS to receive physical custody of my child, under Section 1283 (a) of the California Health and Safety Code, upon completion of any treatment, and I specifically instruct any treating health facility to surrender physical custody of my child to the VBS Director and her officers, agents, servants, or employees that are 18 years of age or older who supervise the activities at this VBS.

It is understood that this authorization is given in advance of any special diagnosis, treatment, transportation or hospital care being required but is given to provide authority and power on the part of the supervisor or his/her authorized designee, in the exercise of his/her best judgment, upon advice of such physician, dentist, and surgeon, may deem advisable.