My child has permission to attend and participate in the aforementioned event sponsored by Pine Street Chapel. In addition, I give permission to Pine Street Chapel’s teachers and directors to photograph my child for promotion & publication purposes. In the case of a medical emergency, I understand that every effort will be made to contact me using the information provided on this form. If attempts fail, I, the Parent or Guardian of the child named on this consent form do hereby authorize a representative from Pine Street Chapel as an agent for the undersigned to consent to any X-ray examination, anesthetic, medical and/or surgical diagnosis and/or treatment and/or hospital care which is deemed advisable by and is rendered under, the general or specific supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment and/or hospital care being required, but is given in advance to provide authority and power on the part of the aforesaid agents to give a specific consent to any and all such diagnosis, treatment or hospital care which the aforesaid physician in the exercise of his best judgment may deem advisable. I further relinquish all claims against and will not hold liable the directors, coordinators, teachers, or any interested parties, including Pine Street Chapel, for any accidents or for obtaining medical treatment for my child.