AUTHORIZATION FOR MEDICAL TREATMENT. In the event of an emergency, I do hereby authorize any and all medical treatment to be provided to me including, without limitation, emergency treatment and transportation, X-ray, anesthetic, dental, medical or surgical diagnosis or treatment by any licensed physician or dentist, as applicable, and any hospital services that might be rendered on my behalf. I hereby assume all responsibility for the expenses associated with the performance of such services. This permission may be revoked at any time by providing notification in writing to the Admission’s Office.
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Samples: Muscogee Nation Enrollment Agreement, cmn.edu, cmn.edu