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Authorization and Consent Form
Centennial Bible Church Vacation Bible School staff needs authorization to act in your child’s best interest. Therefore, your signature below gives your consent for us to: 1. Determine whether an emergency exists. 2. In an emergency, call 911 for assistance or take your child to an outpatient clinic or hospital for medical, dental, or surgical examination. If we arrive before you, this consent authorizes us to approve X-rays, emergency medication, or laboratory procedures which, in the opinion of the physician in charge, are reasonably necessary or advisable. If surgical procedures are needed (e.g. setting a bone or other procedures requiring local or general anesthesia) we will inform you of the emergency and the procedures being followed. Centennial Bible Church, Church staff and/or Vacation Bible School staff will not be responsible for medical expenses incurred; these expenses will be the responsibility of the parent or legal guardian. The completion of this consent form is required for your child to enroll in Centennial Bible Church Vacation Bible School. Your signature acknowledges that you have read this form in its entirety and assume all liability for your child.
Signed in the city of Westfield, Indiana on:___________________________________________________
Signature of Parent or Guardian:___________________________________________________________
Print Parent or Guardian name:____________________________________________________________
Child’s Name(s)_________________________________________________________________________ | 
