B. MEDICAL AUTHORIZATION:I hereby give my permission to the KBLFLC coach, KBLFLC staff, or medical personnel selected by the Director of The Kerwin B. Lee Family Life Center to secure emergency medical treatment including but not limited to, first aid, CPR, authorize emergency transportation, admission to any hospital, tests, surgery or general anesthesia, so long as care is provided by persons or facilities licensed in the State of Georgia. I understand that a conscientious effort will be made to locate me in case of an emergency. However, in the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the director to secure and administer treatment, including hospitalization, for the child named above. Additionally, I give permission to DeKalb Medical Center, 2801 DeKalb Medical Parkway, Lithonia, GA 30058 to treat my child. I further acknowledge that any medical treatment ordered is my financial responsibility and not that of the Kerwin B. Lee Family Life Center, Berean Community Development Corporation, Inc., its board of directors, officers, employees, volunteers, agents, and related and/or affiliated entities, as well as Berean Christian Church, Inc., its board of directors, officers, pastors, employees, volunteers, agents and related and/or affiliated entities.
I CERTIFY THE ABOVE EMERGENCY CONTACT INFORMATION IS TRUE AND CORRECT AND I CONSENT TO THE MEDICAL AUTHORIZATION WRITTEN ABOVE.