I, the undersigned parent or guardian, do hereby authorize emergency medical, dental, health or hospital services to be rendered to my child upon consent of a St. Luke's Episcopal Church staff member or designated volunteer, if needed when involved in activities connected with St. Luke's children's programs, when I or my emergency contact is unavailable to give such consent. This authorization shall be effective from September 2018 through June 2019. My typed name below is my authorization. *