Do you attend or have membership in a Congregation? Yes:(Name)

 As the parent or guardian, I do herewith authorize the treatment by a qualified and licensed medical doctor of the above minor(s) in the event of a medical emergency which in the opinion of the attending physician may endanger life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has be made to reach me. I also release Beth Am Messiah congregation as well as other organizations, congregations and individuals involved with Club Maccabee, of any liability or costs for accidents incurred during any of the Club Maccabee activities.

 I have read and am in agreement with the stipulations of this form. I have signed it of my own free will for the purpose of registering my child in Club Maccabee, a Messianic Jewish Children's Club that teaches that Yeshua (Jesus) is Messiah, for this year and authorizing medical treatment under emergency circumstances in my absence.