I hereby give permission for my child to participate in the WARP’D youth retreat. I hereby release, hold harmless and absolve FCPC, their officers, staff, sponsors, vendors, and all others who participate in the planning, organizing, and implementing of this activity. I understand that in the event my child requires medical treatment while engaged in the activity, reasonable efforts will be made to contact my designated emergency contacts; however, if they cannot be reached, I hereby consent and give my permission to the FCPC staff or any sponsor acting on behalf of FCPC to consent to any x-ray examination, medical, dental, or surgical treatment, hospital care advised and supervised by a physician, surgeon, or dentist licensed to practice under the laws of the state where services are rendered, either as patient or out-patient. To the best of my knowledge, I have listed below all my child’s medical allergies, medications being taken, medical problems and other pertinent information.