I/We the parent(s)/ guardian(s) of the minor named below on this authorization and consent form, do hereby authorize Calvary Chapel South Bay, Inc. as agents for the undersigned to consent to any emergency x-ray, examinations, anesthetic, medical, or surgical diagnosis, or the Medical Practice Act on the medical staff or licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this consent and authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but is given in advance to provide authority and power in the part of aforesaid agents/guardians/parents. This authorization and consent is given pursuant to the provisions of Section 25.8 of the Civil Code of California. The expense of any such treatments and delivery of medical services is agreed to be the sole obligation of the undersigned and not that of Calvary Chapel South Bay, Inc. Calvary Chapel South Bay, Inc. is hereby released from responsibility to pay for such services and treatments rendered.