I do hereby state that I have legal custody of the child(ren), a minor, listed below who resides with me. While this minor is a registered attendee at Calvary Church Vacation Bible School, I hereby authorize any director, counselor, nurse, dean, lifeguard, or other responsible person of said event to consent to any x-ray, examination, anesthetic, medical or surgical treatment, and hospital care, to be rendered to this minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice in the United States, when such medical or surgical treatment is necessary. I also give permission for my child to receive over-the-counter medication from the nurse if necessary.