Consent to Emergency Medical Treatment. The health history above is correct as far as I know, and the Participant has permission to engage in all Program activities noted by me and the examining medical practitioner. I grant Yale, its officers, trustees, agents, employees, students, or volunteers (“Released Parties”) permission to authorize emergency medical and surgical treatment for the Participant, as they deem appropriate. I understand and agree that the Released Parties assume no responsibility for any injury or damage that might arise out of, or in connection, with such authorized emergency medical treatment.
Consent to Emergency Medical Treatment. In the event the above named player required emergency medical treatment and neither parent nor guardian is present to consent, I do hereby consent to such emergency medical treatment as may be required. Acknowledgement of Consent: Parent Signature: Date:
Consent to Emergency Medical Treatment. I consent to all emergency medical treatment that is deemed necessary by first responders and health care providers, until such time that I—or a guardian or person legally authorized to decide for me—is able to make medical decisions. I agree that I am responsible for all costs of treatment.
Consent to Emergency Medical Treatment. I give consent and permission to the “Park”, NESC, or any other Covered Party to obtain on behalf of myself or my minor child any emergency medical attention and treatment in case of sickness, accident or injury and to secure such medical attention and treatment at my sole expense. I recognize that it may be required to transport my minor child to the nearest medical treatment facility based upon their age even though their condition may not warrant it. By signing this document, the undersigned fully recognize that if the Participant or another participant is hurt or property is damaged while the Participant is engaged in this activity, then the undersigned will have no right to make a claim or to file a lawsuit against the Covered Parties, even if they or any of them negligently caused the bodily injury or property damage. I HEREBY CERTIFY THAT I AM OVER 18 YEARS OF AGE OR I AM HAVING MY LEGAL GUARDIAN SIGN THIS DOCUMENT ALSO. I HAVE CAREFULLY READ THE FOREGOING AND ACKNOWLEDGE THAT I UNDERSTAND AND AGREE TO ALL OF THE ABOVE TERMS AND CONDITIONS AND SIGN IT VOLUNTARILY. PRIOR TO SIGNING THIS AGREEMENT, I HAVE REVIEWED THE PARK SAFETY RULES AND REGULATIONS, AND HAVE HAD THE OPPORTUNITY TO ASK ANY AND ALL QUESTIONS ABOUT THE “PARK”, THE PARK STAFF AND/OR THIS AGREEMENT. I AM AWARE THAT BY SIGNING THIS AGREEMENT, I, ON MY OWN BEHALF AND ON BEHALF OF THE PARTICIPANT, ASSUME ALL RISKS AND WAIVE AND RELEASE CERTAIN SUBSTANTIAL RIGHTS THAT I, MY HEIRS, NEXT OF KIN, FAMILY, RELATIVES, GUARDIANS, EXECUTORS, ADMINISTRATORS TRUSTEES AND ASSIGNS OR THE PARTICIPANT MAY HAVE OR POSSESS AGAINST THE “PARK”, NESC, OR ANY OTHER COVERED PARTY.
Consent to Emergency Medical Treatment. The health history above is correct as far as I know, and the Participant has permission to engage in all Program activities noted by me and the examining medical practitioner. I grant Yale, its officers, trustees, agents,
Consent to Emergency Medical Treatment. The health history above is correct as far as I know, and the Participant has permission to engage in all Program activities noted by me and the examining medical practitioner. I grant Harvard and XXXX, its officers, trustees, agents, employees, students, or volunteers (“Released Parties”) permission to authorize emergency medical and surgical treatment for the Participant, as they deem appropriate. I understand and agree that the Released Parties assume no responsibility for any injury or damage that might arise out of, or in connection, with such authorized emergency medical treatment.
Consent to Emergency Medical Treatment. While participating in the program(s), I acknowledge that, on rare occasions, an emer- gency may develop which necessitates the administration of medical care, hospitaliza- tion or surgery. I have fully described any physical or psychological problems I may have on the Student Information Form. In the event of illness or injury to me that would prevent me from authorizing my own treatment, I authorize any official representative of BWRC to secure medical treatment on my behalf, including surgery and the administration of anaesthesia, and I accept all financial responsibility for such treatment.
Consent to Emergency Medical Treatment. While participating in the BWRC/WI program(s), I acknowledge that, on rare occasions, an emergency may develop which necessitates the administration of medical care, hospitalization or surgery. I have fully described any physical or psychological problems I may have on the WI Application Form. In the event of illness or injury to me that would prevent me from authorizing my own treatment, I authorize any official representative of BWRC/WI to secure medical treatment on my behalf, including surgery and the administration of anesthesia, and I accept all financial responsibility for such treatment. X Initial I agree to indemnify BWRC/WI for any losses, liabilities, damages, costs, and/or attorney's fees that they may incur due to my participating in the trip, including losses resulting from my causing injury to another person or my damaging the property of another person or entity. X Initial I recognize the inherent dangers in the activities associated with this course, internship and/or volunteer activity, including the risk of personal injuries, including, but not limited to, the risk of death, the risk of damage to my property, the risk arising from the use of transportation service or living accommodations, and risks arising from weather, illness, quarantine, government rules, war, riots, and strikes. In consideration of my opportunity to participate with BWRC/WI as a student, intern and/or volunteer, and being fully aware of the fact that I might be injured while participating with BWRC/WI, I do hereby agree to assume all risks and responsibilities surrounding my participation. I do for myself, my heirs, and my personal representatives agree to RELEASE, ABSOLVE, and HOLD HARMLESS the Belize Wildlife & Referral Clinic (BWRC) and the Wildlife Institute (WI), the Board of Directors of BWRC/WI, their agents, servants, employees and officials from any and all claims, demands, damages, suits or civil actions resulting from any and all accidents, injuries, or death I might incur while participating with BWRC/WI. X Initial I acknowledge that all information obtained by me during my participation in BWRC/WI activities, including any biological material, remains, samples of any matter, written or oral reports, drawings, plans, maps, renderings, strategies, summaries, written materials, measurements, locations, photographs, analysis, and all other such physical, related or recorded information is considered to be the property of BWRC/WI and/or the Government of B...
Consent to Emergency Medical Treatment. I, if participating in a Pitt-Developed Program (Pitt in China, Italy, London, etc.), acknowledge that on rare occasions an emergency may develop which necessitates the administration of medical care, hospitalization or surgery. Therefore, in event of injury or illness to myself (my son/daughter) necessitating emergency medical care, I hereby authorize the University of Pittsburgh and its authorized representative(s) or agent(s) in charge of the study abroad program, to secure any necessary treatment deemed appropriate, including the administration of anesthetics and surgery. I also acknowledge that medical care abroad may be of varying quality than medical care in the United States, and that I have read and understand the RELEASE at paragraph Q of this contract.
Consent to Emergency Medical Treatment. I authorize emergency medical treatment for the minor registering and I accept full responsibility for all medical expenses incurred as a result of the minor’s participation in any Event.
