Medical Consent. In the event that, , (Birthdate) , may require medical and/or surgical care while I am out of the city or unable to be reached, I hereby give my consent to medical and/or surgical treatment to Hospital and Doctor or his/her designee to provide this care. I agree to pay all the costs and fees contingent on any emergency medical care and/or treatment as secured or authorized under this consent. Signature of Parent/ Guardian Date THE ARC OF Xx XXXXXX COUNTY OPPORTUNITY CENTER PROGRAM RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
Appears in 3 contracts
Samples: Opportunity Center Enrollment Agreement, Opportunity Center Enrollment Agreement, Opportunity Center Enrollment Agreement
Medical Consent. In the event thatthat my child, , (Birthdate) , may require medical and/or surgical care while I am out of the city or unable to be reached, I hereby give my consent to medical and/or surgical treatment to Hospital and Doctor or his/her designee to provide this care. I agree to pay all the costs and fees contingent on any emergency medical care and/or treatment for my child as secured or authorized under this consent. Signature of Parent/ Guardian Date THE ARC OF Xx XXXXXX COUNTY OPPORTUNITY CENTER PROGRAM RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENTAFTER SCHOOL PROGRAM
Appears in 3 contracts
Samples: Enrollment Agreement, Enrollment Agreement, Enrollment Agreement
