EMERGENCY MEDICAL AUTHORIZATION. I give permission for emergency medical/dental treatment or first aid to be administered to my child for any illness/injury/accident resulting from participation in Pop Warner activities.
EMERGENCY MEDICAL AUTHORIZATION. I hereby authorize any medical treatment deemed necessary in the event of any injury while participating in the Events. I have appropriate insurance, or in its absence, agree to pay all costs of rescue and/or medical services as may be incurred on my behalf.
EMERGENCY MEDICAL AUTHORIZATION. In the event of a medical emergency, I hereby consent to the provision of medical treatment deemed necessary or advisable if Sailor is injured or requires medical attention during participation in the Activity. I understand that effort will be made to contact the undersigned/emergency contact prior to rendering treatment to Sailor, but that medical treatment will not be withheld if I/emergency contact cannot be reached. I understand and agree that I am solely responsible for all costs related to such medical treatment and any related medical transportation and/or evacuation. I hereby release, forever discharge, and hold harmless the Sailing Club from any claim based on such treatment or other medical services.
EMERGENCY MEDICAL AUTHORIZATION. I hereby give permission for the staff of the Merrimack Valley YMCA, to provide basic first aid and/or CPR/AED treatment to my child, , when necessary. In the event of a more serious illness or injury, I give permission for my child to be transported to a hospital or other emergency medical facility to receive emergency medical treatment. I also authorize ambulance/rescue squad attendants to administer such treatment as is medically necessary, and I authorize licensed health practitioners working in the hospital or emergency medical facility to examine and provide emergency medical treatment to my child if warranted. I understand that YMCA personnel will make every effort to contact me regarding any emergency involving my child. / / Parent/Guardian Signature Date Child’s Physician: Phone #: Physician’s Address:
EMERGENCY MEDICAL AUTHORIZATION. Student and Parent hereby request, authorize and give full permission and consent to the Envision Parties to act on behalf of Student and Parent and in their stead should Student become ill, be injured or require emergency or other medical treatment, including hospitalization and/or surgery, during the Program. Student and Parent further authorize Envision to contact Xxxxxx and Student’s emergency contact(s) and discuss the nature of Student’s illness or injury with such emergency contact(s). Student and Parent understand and agree that in the event of such illness or injury, Student will, if it appears necessary in the judgement of Envision Parties, be taken to an urgent care facility or a hospital emergency room and examined by physician and/or other medical professional. If the physician or medical professional determines that Student does not require hospitalization but should not continue as a Program participant, at the written direction of the physician or medical professional, Student may either be sent home promptly, or Envision will consult with the family on options for the participant until such time as a physician or other medical professional determines that Student is able to safely travel home or rejoin the Program activities. In the event of a reportable communicable disease, as defined by the applicable state’s Board of Health or if a physician or medical professional advises that the Student may not rejoin the Program, Parent is responsible for retrieving Student from the Program or to arrange for Student’s safe travel home, at Parent’s expense, within 24 hours. When deciding upon, consenting to or declining medical treatment, Student and Parent understand and agree that the Envision Parties will use reasonable judgment under the circumstances and will defer to the expertise of any medical practitioner who provides services to Student. Other than covered expenses for emergency medical care included within the Tuition, or covered by any supplemental coverage purchased under Student’s Tuition and Travel Protection Plan, as applicable, Student and/or Parent agree to be solely responsible for all expenses incurred as a result of any accident, illness and/or injury suffered by Student and to reimburse the Envision Parties for such expenses paid by Envision. Student and Parent hereby release and agree to hold harmless the Envision Parties from all claims, demands, damages, expenses, whether known or unknown, resulting from, arising out of, or ...
EMERGENCY MEDICAL AUTHORIZATION. (Parent/Guardian please complete) My child has the following medical conditions, which may require special attention:
EMERGENCY MEDICAL AUTHORIZATION. I, the undersigned, do hereby authorize Xxxxxxx State University and its agents or representatives to consent, on my behalf, to any medical/hospital care or treatment (including locations outside the U.S.) to be rendered upon the advice of any licensed physician. I agree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization.
EMERGENCY MEDICAL AUTHORIZATION. I authorize to obtain immediate consent and care to
EMERGENCY MEDICAL AUTHORIZATION. I, the undersigned, do hereby authorize Xxx Houston State University and its agents or representatives to consent, on my behalf, to any medical/hospital care or treatment (including locations outside the U.S.) to be rendered upon the advice of any licensed physician. I agree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization.
EMERGENCY MEDICAL AUTHORIZATION. The parent/guardian shall execute an Emergency Medical Authorization form which will enable the Producer to obtain necessary emergency medical treatment for the Minor.
