• I hereby authorize ALLASO RANCH to take me to the before named physician or facility for medical treatment in the event of an emergency in which neither parent can be reached after reasonable attempt to do so.
• I hereby give permission for me to attend and participate in activities sponsored by ALLASO RANCH and/or Fellowship Church.
• I hereby authorize ALLASO RANCH to transport me to or from church and/or any other church related and sponsored activities and events.
• I authorize ALLASO RANCH to include me in routinely supervised water activities.
• I hereby authorize ALLASO RANCH to consent to any x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care to be rendered to me under the general or special supervision and on the advice of any physician or dentist representing to be licensed on the medical staff of a hospital or medical care facility, whether such diagnosis or treatment is rendered at the office of said physician or at the said facility or hospital.
• I hereby do authorize ALLASO RANCH to dispense to me any over-the-counter medications (according to proper dosage instructions) when reasonably deemed necessary.
• I do hereby authorize any physician, dentist, hospital or medical treatment center to treat me in the case of emergency in which the before named physician or dentist cannot respond. The undersigned adult shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for me to return home due to medical reasons or otherwise, the undersigned shall assume and be responsible for the payment of all transportation costs.
• I hereby release, forever discharge and agree to defend and hold harmless ALLASO RANCH from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned adult that occur while said adult is participating in any trip or activity with ALLASO RANCH.
• I hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation in recreation and work activities involved therein.
• Further authorization and permission is hereby given to ALLASO RANCH to furnish any necessary transportation, food, and lodging for me. The undersigned further hereby agrees to hold harmless and indemnify ALLASO RANCH from and against any claim against or loss incurred by ALLASO RANCH as the result of the negligent, willful or intentional acts of me, including any expense incurred attendant thereto. The medical consent and liability waiver provisions hereof shall remain in full force and in effect until written notice of revocation or withdrawal is received by ALLASO RANCH at its office at 2302 Private Road 7850, Hawkins, Texas, Wood County, Texas.
• I acknowledge and agree that it is my (our) responsibility to notify Allaso Ranch of any changes in medical condition, guardianship, address or telephone, in writing to the address listed at the beginning of this form.

The undersigned person, by his/her signature below, acknowledges that he/she has received a written copy of the foregoing Fellowship Church’s Policies to Procedures for the Prevention of Child Abuse, that he/she has read and understood them, that he/she agrees to be bound by and comply with them, that he/she has never engaged in any conduct that would be considered child abuse or been under suspicion for or investigated for allegations of child abuse, that if he/she is accused of or under investigation for conduct alleged to be child abuse after the date of his/her signature to this document he/she will immediately notify Fellowship Church, cease any involvement or interaction with children at the Church until such charges can be investigated, and that he/she knows of no reason why he/she should not be allowed to work with or interact with children brought to or under the care or supervision of Fellowship Church.