As a parent and/or guardian of the above-named, I do herewith authorize treatment under the direction of any licensed physician of the above-named minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. The authority is granted only after a reasonable effort has been made to reach me by the phone numbers listed above. The undersigned assumes responsibility for any costs connected with such treatment, and hereby releases the church where the child attends Awana Club from any liability therefore. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.