Therefore, I certify that I, (name of parent) , am the father of OROMACHI AMADI. The above conditions are the accidents, risks and complications that may occur in this treatment, these conditions have been fully explained by the doctor, I fully understand the possible risks. I take full responsibility for this decision which may result in the risks and complications mentioned above and give consent to Xi’an Fengcheng Hospital to treat my daughter.Signature of Parent: Date: