IN CASE OF EMERGENCY, I hereby authorize an adult leader from or staff member of the Christian Church of Clarendon Hills, as an agent for me, to consent to any X-ray examination; medical, dental, or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state or country where the services are rendered, either at a doctor’s office or in any hospital.