MEDICAL AUTHORIZATION AND PHOTO RELEASE

In case of an emergency, I know Northside Baptist Church will make every reasonable attempt to promptly contact the parent or guardian. I hereby authorize Northside Baptist Church and its representative to select transportation for my child to their chosen licensed physician who may use upon and administer to the said child while attending him/her: x-ray examination, anesthetic, medical or surgical diagnosis or treatment, order injections, or hospitalize, as in the opinion of such physician is deemed necessary or advisable.

I hereby give consent for my child to appear in photographs, audiovisual productions, and/or any other means of publication media taken and used by Northside Baptist Church and its assigns or successors.

I have carefully read this release and understand and agree with all of its terms and conditions. I represent that I am the parent/guardian of the participant. By signing electronically, I consent to the terms outlined above and agree that my electronic signature has the same legal effect as a handwritten signature under California law (California Uniform Electronic Transactions Act, Civ. Code § 1633.1 et.seq.).

I understand that this electronically signed waiver will be securely stored and will remain accessible for future reference in compliance with state and federal laws.

This authorization is valid for all meetings effective 9/9/26 through 5/31/27.

Please select the appropriate option (children from same household only):

• If this is the first child you are registering, please select "1st child registered or I am only registering 1 child".


• If this is the second child you are registering, please select "2nd child registered".


• If this is the third child you are registering–or any child after that, please select "3rd or more child registered".