Common use of Emergency Medical Care Clause in Contracts

Emergency Medical Care. In the event that I or an alternative contact provided in writing to Kettering Health cannot be reached in the event of an emergency, I authorize Kettering Health and its representatives to act on my behalf with respect to the provision of such care, and I consent for any and all treatment. I further agree to use my or the Minor Participant’s personal medical insurance as a primary medical coverage payment if accident or injury occurs and agree to pay all costs and expenses incurred in connection with any medical care provided, including the cost of transportation. This Release and Waiver will be governed by and interpreted in accordance with the laws of the State of Ohio. I agree that any action arising out of this an Event or this Release and Waiver must be brought exclusively in any state or federal court located in Montgomery County, Ohio. If any provision of this Release and Waiver is deemed invalid, void or unenforceable, such provision shall be considered severed from this Release and Waiver and the remaining provisions shall be given full force and effect. No change, modification, amendment, or addition of or to this Release and Waiver shall be valid unless in writing and signed by Kettering Health’s Chief Legal Officer. This Release shall be binding upon and inure to the benefit of the successors, assigns, and legal representatives of the parties. I HAVE READ AND VOLUNTARILY SIGN THIS WAIVER AND RELEASE AND DO SO WITH THE UNDERSTANDING THAT SUBSTANTIAL RIGHTS ARE BEING GIVEN UP. I UNDERSTAND THAT THE MINOR PARTICIPANT’S PARTICIPATION IN THIS EVENT IS VOLUNTARY AND RELEASING THE RELEASED PARTIES IS PART OF THE CONSIDERATION FOR THE MINOR PARTICIPANT BEING ALLOWED TO PARTICIPATE. FOR THE AVOIDANCE OF DOUBT, THIS RELEASE AND WAIVER SHALL COVER EACH EVENT THE MINOR PARTICIPANT PARTICIPATES IN WITH KETTERING HEALTH. I HAVE READ THIS RELEASE AND WAIVER Check One: Parent or Guardian (Signature)  Father  Mother  Guardian Print Name Emergency Contact Number Date Name of Minor Participant: Please print clearly and complete one form per Minor Participant if you have more than one minor participating in an Event or Events. Date of Birth:

Emergency Medical Care. In the event that I or an alternative contact provided in writing to Kettering Health cannot be reached in the event of an emergency, I authorize Kettering Health and its representatives to act on my behalf with respect to the provision of such care, and I consent for any and all treatment. I further agree to use my or the Minor Participant’s personal medical insurance as a primary medical coverage payment if accident or injury occurs and agree to pay all costs and expenses incurred in connection with any medical care provided, including the cost of transportation. This Release and Waiver will be governed by and interpreted in accordance with the laws of the State of Ohio. I agree that any action arising out of this an Event or this Release and Waiver must be brought exclusively in any state or federal court located in Montgomery County, Ohio. If any provision of this Release and Waiver is deemed invalid, void or unenforceable, such provision shall be considered severed from this Release and Waiver and the remaining provisions shall be given full force and effect. No change, modification, amendment, or addition of or to this Release and Waiver shall be valid unless in writing and signed by Kettering Health’s Chief Legal Officer. This Release shall be binding upon and inure to the benefit of the successors, assigns, and legal representatives of the parties. I HAVE READ AND VOLUNTARILY SIGN THIS WAIVER AND RELEASE AND DO SO WITH THE UNDERSTANDING THAT SUBSTANTIAL RIGHTS ARE BEING GIVEN UP. I UNDERSTAND THAT THE MINOR PARTICIPANT’S MY PARTICIPATION IN THIS EVENT IS VOLUNTARY AND RELEASING THE RELEASED PARTIES IS PART OF THE CONSIDERATION FOR THE MINOR PARTICIPANT ME BEING ALLOWED TO PARTICIPATE. FOR THE AVOIDANCE OF DOUBT, THIS RELEASE AND WAIVER SHALL COVER EACH EVENT THE MINOR PARTICIPANT PARTICIPATES I PARTICIPATE IN WITH KETTERING HEALTH. I HAVE READ THIS RELEASE AND WAIVER Check One: Parent or Guardian (Signature)  Father  Mother  Guardian Signature Print Name Emergency Contact Number Date Name of Minor Participant: Please print clearly and complete one form per Minor Participant if you have more than one minor participating in an Event or Events. Date of Birth:Name

Emergency Medical Care. In the event that I or an alternative contact provided in writing to Kettering Health cannot be reached in the event of an emergency, I authorize Kettering Health and its representatives to act on my behalf with respect to the provision of such care, and I consent for any and all treatment. I further agree to use my or the Minor Participant’s personal medical insurance as a primary medical coverage payment if accident or injury occurs and agree to pay all costs and expenses incurred in connection with any medical care provided, including the cost of transportation. This Release and Waiver will be governed by and interpreted in accordance with the laws of the State of Ohio. I agree that any action arising out of this an Event or this Release and Waiver must be brought exclusively in any state or federal court located in Montgomery Xxxxxxxxxx County, Ohio. If any provision of this Release and Waiver is deemed invalid, void or unenforceable, such provision shall be considered severed from this Release and Waiver and the remaining provisions shall be given full force and effect. No change, modification, amendment, or addition of or to this Release and Waiver shall be valid unless in writing and signed by Kettering Health’s Chief Legal Officer. This Release shall be binding upon and inure to the benefit of the successors, assigns, and legal representatives of the parties. I HAVE READ AND VOLUNTARILY SIGN THIS WAIVER AND RELEASE AND DO SO WITH THE UNDERSTANDING THAT SUBSTANTIAL RIGHTS ARE BEING GIVEN UP. I UNDERSTAND THAT THE MINOR PARTICIPANT’S PARTICIPATION IN THIS EVENT IS VOLUNTARY AND RELEASING THE RELEASED PARTIES IS PART OF THE CONSIDERATION FOR THE MINOR PARTICIPANT BEING ALLOWED TO PARTICIPATE. FOR THE AVOIDANCE OF DOUBT, THIS RELEASE AND WAIVER SHALL COVER EACH EVENT THE MINOR PARTICIPANT PARTICIPATES IN WITH KETTERING HEALTH. I HAVE READ THIS RELEASE AND WAIVER Check One: Parent or Guardian (Signature)  Father  Mother  Guardian Print Name Emergency Contact Number Date Name of Minor Participant: Please print clearly and complete one form per Minor Participant if you have more than one minor participating in an Event or Events. Date of Birth:

Emergency Medical Care. In the event that I or an alternative contact provided in writing to Kettering Health cannot be reached in the event of an emergency, I authorize Kettering Health and its representatives to act on my behalf with respect to the provision of such care, and I consent for any and all treatment. I further agree to use my or the Minor Participant’s personal medical insurance as a primary medical coverage payment if accident or injury occurs and agree to pay all costs and expenses incurred in connection with any medical care provided, including the cost of transportation. This Release and Waiver will be governed by and interpreted in accordance with the laws of the State of Ohio. I agree that any action arising out of this an Event or this Release and Waiver must be brought exclusively in any state or federal court located in Montgomery Xxxxxxxxxx County, Ohio. If any provision of this Release and Waiver is deemed invalid, void or unenforceable, such provision shall be considered severed from this Release and Waiver and the remaining provisions shall be given full force and effect. No change, modification, amendment, or addition of or to this Release and Waiver shall be valid unless in writing and signed by Kettering Health’s Chief Legal Officer. This Release shall be binding upon and inure to the benefit of the successors, assigns, and legal representatives of the parties. I HAVE READ AND VOLUNTARILY SIGN THIS WAIVER AND RELEASE AND DO SO WITH THE UNDERSTANDING THAT SUBSTANTIAL RIGHTS ARE BEING GIVEN UP. I UNDERSTAND THAT THE MINOR PARTICIPANT’S MY PARTICIPATION IN THIS EVENT IS VOLUNTARY AND RELEASING THE RELEASED PARTIES IS PART OF THE CONSIDERATION FOR THE MINOR PARTICIPANT ME BEING ALLOWED TO PARTICIPATE. FOR THE AVOIDANCE OF DOUBT, THIS RELEASE AND WAIVER SHALL COVER EACH EVENT THE MINOR PARTICIPANT PARTICIPATES I PARTICIPATE IN WITH KETTERING HEALTH. I HAVE READ THIS RELEASE AND WAIVER Check One: Parent or Guardian (Signature)  Father  Mother  Guardian Signature Print Name Emergency Contact Number Date Name of Minor Participant: Please print clearly and complete one form per Minor Participant if you have more than one minor participating in an Event or Events. Date of Birth:Name