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  • Children's and Student Ministry Media Release

  • In exchange for consideration received, I as parent/legal guardian hereby give permission to the First Presbyterian Church of Fairfield to use my child's photographic likeness in all forms and media for advertising, trade, and any other lawful purposes.

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  • Medical Care and Health Insurance









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  • Parental Medical Consent/Liability Release

  • This field must be completed and signed by a Parent/Guardian for any minor child who wants to participate in any First Presbyterian Church of Fairfield Children's and/or Student Ministry activity.

                The undersigned(s) being lawful parent(s) and/or guardian(s) of the above named minor child, hereby consents to the participation of my child in the First Presbyterian Church of Fairfield Children's and/or Student Ministry and all Children's and/or Student Ministry related activities conducted by First Presbyterian Church of Fairfield. The undersigned hereby further authorizes any of the staff, employees, volunteers, directors, and agents of First Presbyterian Church of Fairfield to provide for, approve, and authorize any health care at any hospital, emergency room, doctor’s office, or other institution; employ any physicians, dentists, nurses, or other person whose services may be needed for such health care; review and if necessary disclose the contents of any medical records; execute any consent form required by medical, dental, or other health authorities incident to the provision of medical, surgical, or dental care to the Student. Health care shall include but not be limited to the administration of anesthesia, X-ray examination, performance of operations, diagnostic and other procedures.

                If there is no medical emergency, First Presbyterian Church of Fairfield will first use reasonable efforts to contact the parent(s)/guardian(s) before administering or authorizing any treatment. Notwithstanding other provisions in this Consent Form, First Presbyterian Church of Fairfield shall not have the authority to withhold or withdraw life-sustaining procedures for my child.

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