Medical Authorization. In the event of illness or injury while participating in the above referenced activity, I hereby consent to whatever x-ray, examination, anesthetic, medical, surgical, dental diagnosis or treatment, hospital care and emergency transportation from a licensed physician, surgeon, and/or dentist as deemed necessary for my safety and welfare.
Appears in 9 contracts
Samples: Student Agreement and Medical Release for Classroom Related Travel, Student Agreement and Medical Release, Student Agreement and Medical Release
Medical Authorization. In the event of illness or injury while participating in the above referenced activity, I hereby consent to whatever any necessary x-ray, examination, anesthetic, medical, surgical, dental diagnosis or treatment, hospital care and emergency transportation from a licensed physician, surgeon, and/or dentist as deemed necessary for my safety and welfare.. Participant’s Medical Insurance Carrier Policy # Insurance Carrier Phone # In the event of an illness, accident, or other emergency, please notify:
Appears in 4 contracts
Samples: Student Agreement and Medical Release, Student Agreement and Medical Release, Student Agreement and Medical Release
Medical Authorization. In the event of any illness or injury while participating in the above referenced activityinjury, I hereby consent to whatever xX-ray, examination, anesthetic, medical, surgicaldental, dental or surgical diagnosis or treatment, treatment and hospital care and emergency transportation from a licensed physician, surgeon, physician and/or dentist as surgeon is deemed necessary for my safety and welfare.
Appears in 1 contract
Samples: Study Abroad Program Student Participation Agreement