*To register more than 4 children, please complete a second form.

I, the legal parent/guardian of the child listed on this form, hereby authorize and consent to the use of images or videos of my child listed above, with or without their name, by San Juan Baptist Church for the purposes including but not limited to: promotional materials, printed publications, internet posts including social media, television, and other media sources. I do this with full knowledge and consent and waive all claims for compensation for use or for damages. I release San Juan Baptist Church, it’s officers, trustees, employees, and agents from liability for any claims by me or any third party in connection with the use of the image of my child listed above.

Being the parent or legal guardian of the child listed on this form, I do consent to any x-ray, anesthetic, medical, surgical, or dental diagnosis or treatment that may be deemed necessary for my minor child. Further, I understand that all efforts will be made to contact me prior to treatment. In the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child. I further understand that the doctors, dentists, and other providers attending to my child will take all reasonable safety precautions during their care. Further, as parent or legal guardian, I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for the dental, medical, or hospital care or treatment that is given to my child. Any policy of the organization sponsoring this event will be used as the secondary coverage. Minor’s date