By typing my full name below, I recognize that I am the parent or legal guardian of the child or children listed above, hereinafter referred to as “my child”. My child is attending and participating in ministry activities of Gallatin First Church of the Nazarene, hereinafter referred to as GFCN, located at 407 N Water Ave., Gallatin, TN 37066.

I hereby authorize the Pastor to Kids, Pastor to Youth, and his/her officers, agents, or employees who are 18 years of age or older, who supervise the activities at GFCN into whose care my child has been entrusted, to consent to medical care for my child.

The authority granted by this authorization includes the authority to consent for my child to any x-ray examinations, anesthetic, medical, or surgical diagnosis or treatment and hospital care under the general or special supervision and upon the advice of, or to be rendered by, a physician and surgeon licensed under the Medical Practice Act.

It is understood that this authorization is given in advance of any special diagnosis, treatment, or hospital care being required, but is given to provide the authority and power on the part of the Pastor to Kids or Pastor to Youth and his/her authorized designee to exercise his/her best judgment on what is advisable for my child’s care, upon advice of such physician or surgeon.