B-1-g-1
Miscellaneous medical lab test for Dana Lewis, September 1976
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B-1-g-2a – 2b
PARENTAL CONSENT
AND POWER OF ATTORNEY
STATE OF CALIFORNIA
COUNTY OF San Francisco
UNITED STATES OF AMERICA
I, Christopher Lewis hereby declare
- I am the natural father legal guardian of Dana Lewis, a minor, born 3/25/70
- I hereby consent to said minor going to Guyana, South America, to live and be cared for there under the Guardianship or custody of Joyce Touchette or whomever she appoints in her place.
I hereby appoint Eva Pugh of Redwood Valley, Calif. and Joyce Touchette of Jonestown, Guyana and Debbie Touchette of Georgetown, Guyana, SA as my attorneys-in-fact, jointly and severally, to take any and all action any of them deem fit for the welfare of said minor. By this power of attorney, I give each of the aforesaid attorneys-in-fact the right to the care, custody, supervision, and control of said minor anywhere throughout the world, and to travel anywhere with said minor throughout the world.
[signed by Chris Lewis, notarized by Jim Randolph, December 5, 1976]
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B-1-g-3a – 3b
Duplicate of B-1-g-2a – 2b
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B-1-g-4a – 4b
LIMITED POWER OF ATTORNEY
CONSENT TO TRAVEL AND VISIT AND
RELEASE OF LIABILITY
I, the undersigned, am the natural father/ natural mother/ legal guardian/ of Dana Lewis, a minor of the age of 6 years. I hereby appoint Eva Pugh, Debbie Touchette, and Joyce Touchette as my attorneys-in-fact, jointly and severally, to take any and all action any of such deem fit with respect to the welfare and custody of said minor, including disciplining, supervising, and authorizing medical care and treatment. This limited power of attorney shall be effective commencing immediately and remaining in effect until written notice of written revocation is made to each said attorney-in-fact. This power of attorney shall be valid and effective at all times that said minor is not in my physical custody and is engaged in an activity sponsored directly or indirectly by Peoples Temple of the Disciples of Christ, also known as Peoples Temple Christian Church. In the event any of the aforesaid attorneys-in- fact are unable or unwilling to act as an attorney-in-fact, he or she may designate any other adult member of said church as attorney-in-fact in his or her stead.
I further give my consent to said minor travelling on the buses of said church and to participate in any and all transportation and visitation activities sponsored directly or indirectly by said church during the aforesaid period of time.
I further release Peoples Temple of the Disciples of Christ, its Pastor, its bus drivers, and all members of said church from any and all liability for any injuries resulting in any acts of commission or omission occurring while said minor is in any way engaged in an activity or on any trip sponsored directly or indirectly by Peoples Temple Christian Church.
(Note: use the same attorneys-in-fact as on Parental Consent form.)
[notarized by Jim Randolph, December 5, 1976]
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B-1-g-5a – 5b
Duplicate of B-1-g-4a – 4b
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B-1-g-6
RELEASE AS TO SELF AND MINOR
I hereby declare I am the [blank space] of [blank space], a minor, and have full legal custody thereof, and enter into this release of liability with respect to myself and said minor.
I hereby release Peoples Temple of the Disciples of Christ, a California corporation, and any and all of its members, and Pastor Jim Jones, of any and all liability, claims, causes, and causes of action arising out of or relating to said minor’s travels to and from and visit in any and all foriegn countries including Guyana, South America, including but not limited to the airplane flights to and from said destination and accompanying means of transportation while there.
In the event that I should elect that said minor remain for a period of time at such destination, including Guyana, South America, I herewith release Peoples Temple of the Disciples of Christ, a California corporation, and any and all of its members, and Pastor Jim Jones, of any and all liability arising out of or related to said minor’s activities, travel, and any illnesses that might arise by natural or other causes while, there.
I hereby acknowledge that I have requested said corporation and said members and said Pastor that said minor may go on said trip and remain in said places. If said minor is permitted to remain at any such place, I hereby promise on his/her behalf that he/she will work diligently and in full co-operation with’ all leadership appointed by said Pastor, directly or indirectly, and will keep a cheerful and constructive attitude at all times. If said minor fails to keep this promise, it is understood that I will be solely responsible for any and all costs and other obligations incurred in said minor’s returning from as well as going to and living in said place.
I declare under penalty of perjury that the foregoing is true and correct.
[signed by Chris Lewis, notarized by Jim Randolph, December 5, 1976]
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B-1-g-7
Duplicate of B-1-g-6