The undersigned do hereby give and grant consent and permission to the First Congregational church of Kokomo, IN, for their children to be transported with and participate in activities with First Congregational church and the adults entrusted as supervisors. I hereby agree to indemnify and hold harmless First Congregational church, or any drivers, supervising adults, or any other youth, from liability that may occur from injuries resulting during any trips or activities. I authorize an adult, in whole care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or medical treatment is rendered at the office of said physician or at said hospital.

The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.

The undersigned understands that students are to remain with First Congregational Church or any supervising adults during the duration of the trip or activity unless leaders are otherwise notified prior to the event. (Examples include but are not limited to leaving early, being picked up from a location that differs from the rest of the group, etc.)