AUTHORIZATION FOR EMERGENCY MEDICAL CARE. I hereby pre-authorize the Event Organizers and their representatives to arrange for emergency medical treatment and/or transport via ambulance or air on my behalf if medical attention is warranted during my participation in the Event. I understand and agree that I will be responsible for the costs associated with any such emergency medical care and/or transport arranged on my behalf, and hereby release the Event Organizers from any Liability relating to the cost and provision of any rescue operations, first aid treatment, medical care, hospital expenses or the medical decisions made at the Event site or elsewhere on my behalf.
AUTHORIZATION FOR EMERGENCY MEDICAL CARE. In case of accident or illness requiring immediate medical attention, the undersigned authorizes (Name of Day Care Provider) _ to call a physician or to take my/our child(ren) to the nearest hospital or doctor. Doctor Contact Doctor Name: _ Address: Phone: _ It is understood that if possible, his/her service will be obtained. If neither the parents nor the doctor can be contacted, Jelly Bean Group Family Day Care provider is authorized to contract another doctor. It is also understood that this agreement covers only those situations which, in the best judgment of Jelly Bean Group Family Day Care provider, are true emergencies. Otherwise, we (I) expect to be notified of illness or accident at once and shall make our/my own arrangement for medical care for our /my child(ren) with the physician or hospital of my/our choice. Intending to be legally bound hereby, we (I) agree to pay all reasonable expenses incurred. _ Parent signature Date _ Parent signature Date _ Name of child(ren) Date
AUTHORIZATION FOR EMERGENCY MEDICAL CARE. In case of accident or illness requiring immediate medical attention, the undersigned authorizes (Name of Day Care Provider) to call a physician or to take my/our child(ren) to the nearest hospital or doctor. Doctor Contact Doctor Name: Address: Phone: It is understood that if possible, his/her service will be obtained. If neither the parents nor the doctor can be contacted, Jelly Bean Group Family Day Care provider is authorized to contract another doctor. It is also understood that this agreement covers only those situations which, in the best judgment of Jelly Bean Group Family Day Care provider, are true emergencies. Otherwise, we (I) expect to be notified of illness or accident at once and shall make our/my own arrangement for medical care for our /my child(ren) with the physician or hospital of my/our choice. Intending to be legally bound hereby, we (I) agree to pay all reasonable expenses incurred. Parent signature Date Parent signature Date Name of child(ren) Date
AUTHORIZATION FOR EMERGENCY MEDICAL CARE. In the event I am rendered unable to communicate by an emergency or accident, I authorize and request such medical and surgical services as may be necessary, and agree to accept financial responsibility for same. I further understand that remote locations may result in delayed delivery of emergency services. My signature on this document is intended to bind my heirs, representatives, executors, or administrators. I further understand that if I am signing below as a Parent/Guardian, that I am accepting all terms on behalf of myself and my minor child, and that all conditions of participation apply for the minor child, and that I have appropriate legal authority to act on behalf of the minor child listed below. PARTICIPANT'S SIGNATURE DATE PARENT/GUARDIAN'S SIGNATURE DATE (Required if participant is under 18 years of age) ANYONE WITH SEVERE ALLERGIES TO FOOD, PLANTS OR INSECTS MUST INFORM CCPRC STAFF, BRING THEIR OWN MEDICATION, AND BE ABLE TO SELF-ADMINISTER IT
AUTHORIZATION FOR EMERGENCY MEDICAL CARE. In the event I sustain injury or illness while participating in MBA Events, I authorize licensed medical personnel to perform or administer to me on an emergency basis any first-aid, medication, medical treatment or surgery that they in good xxxxx xxxx necessary. I also give permission for attending emergency medical personnel to execute on my behalf my permission forms or other necessary medical documents and to act in my behalf if I am unable to do so and if no other person is present who is legally authorized to consent to emergency treatment for me.
AUTHORIZATION FOR EMERGENCY MEDICAL CARE. I grant the Beltonian Theatre staff and directors the authority to obtain and consent to emergency medical care for my child if they deem it necessary. I retain full responsibility for the payment for any such emergency care.
