Either parent, or a guardian having legal custody of a minor may give written authorization for an adult into whose care the minor has been entrusted to consent to X-ray examinations, anesthesia, medical or surgical diagnosis, and/or treatment and hospital care to be rendered to said minor under the general or special supervision and advice of a physician or surgeon licensed under the provisions of the Medical Practice Act, or to X-ray examinations, anesthesia, dental and/or surgical diagnosis or treatment and hospital care to be rendered to said minor by a dentist licensed under the provisions of the Dental Practice Act. AUTHORIZATION: I hereby authorize Temple Emanuel of Beverly Hills and its schools to procure medical, hospital, or dental care for child(ren) named above in the event of injury or illness while the child(ren) is (are) in the care of the above named facility or person(s). I HEREBY RELEASE, DISCHARGE AND AGREE TO HOLD HARMLESS, to the fullest extent permitted by law, Temple Emanuel of Beverly Hills and its schools, employees, volunteers, and other representatives for the provision of this care. I further acknowledge and accept that this Disclaimer, Assumption of Risk and Waiver is intended to be as broad and inclusive as permitted by the laws of the state of California and agree that if any portion of this Disclaimer, Assumption of Risk and Waiver is deemed to be invalid, the remainder will continue in full legal force and effect. ACKNOWLEDGEMENT AND CONSENT: It is further understood that the undersigned will assume full responsibility for any such treatment, including the payment of all costs and expenses. I further acknowledge and accept that this Disclaimer, Assumption of Risk and Waiver is intended to be as broad and inclusive as permitted by the laws of the state in which we live and agree that if any portion of this Disclaimer, Assumption of Risk and Waiver is deemed to be invalid, the remainder will continue in full legal force and effect.