PERMISSION TO SECURE TREATMENT Sample Clauses

PERMISSION TO SECURE TREATMENT. In the event of an emergency, I authorize Mattock School of Music officials to secure treatment (from licensed hospital, physician, and/or medical personnel) necessary for my child’s/xxxx’x care and I will be responsible for payment of any and all medical services required.
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PERMISSION TO SECURE TREATMENT. In the event of an emergency, Participant authorizes Loras College to secure any treatment deemed necessary from any licensed hospital, physician, and/or medical personnel and agrees to be responsible for payment of any and all services rendered. Participant has read and fully understands this entire document and declares that all information supplied by Participant is accurate and current. ____________________________________________________ Participant’s Name(s) (please print) 0000 Xxxx Xxxxx Xxxxxx | Xxxxxxx, XX 00000 2014 LORAS COLLEGE SUMMER VOLLEYBALL CAMPS Address Parent’s or Guardian’s Name (please print) ____________________________________________________ Relationship to Participant (If any Participant is a minor.) Participant Signature(s) Date (Must be signed by Parent or Guardian if any Participant is a minor.) BE MORE. BE LORAS. 2014 LORAS COLLEGE SUMMER VOLLEYBALL CAMPS ELEMENTARY AND JUNIOR HIGH CAMPS July 21-24, 2014 XXXXX.XXX TOTAL ENCLOSED $ 2014 LORAS COLLEGE SUMMER VOLLEYBALL CAMPS 2014 VOLLEYBALL CAMP REGISTRATION FORM MUST FILL OUT BOTH SIDES OF THIS FORM AND SIGN XXXXXX AND RELEASE ON BACK. REGISTRATION IS NOT COMPLETE IF WAIVER AND RELEASE ON BACK IS NOT FILLED OUT AND SIGNED. ELEMENTARY AND JUNIOR HIGH CAMPS July 21-24, 2014 ELEMENTARY CAMP Students entering grades 4, 5, or 6 (in fall 2014) – Cost: $80 9:30 a.m.-12:00 noon (first day check-in at 9:00-9:30 a.m.) JUNIOR HIGH CAMP Students entering grades 7 or 8 (in fall 2014) – Cost: $80 1:30-4:00 p.m. (first day check-in at 1:00-1:30 p.m.) q Junior High–$80 PLACE Athletic and Wellness Center, Loras College, 0000 Xxx Xxxxxx, Dubuque, Iowa. CAMP DIRECTOR - COACH XXXXX Xxxx Desired (check box that applies): q Elementary–$80 Xxxxx Xxxx just completed her first season as the Loras College women’s head volleyball coach. She helped the Duhawks to a third place finish in the Iowa Conference. She coached one First-Team All-Conference player, as well as two Honorable Mention All-Conference players in her first season. DEADLINE Registration, payment, and filled out and signed waiver for all camps are due by Wednesday, July 8, 2014. IMPORTANT: Your registration is NOT COMPLETE if Waiver and Release is NOT FILLED OUT AND SIGNED. NEED MORE INFO? Please call Coach Xxxxx at 000-000-0000 or e-mail xxxxx.xxxx@xxxxx.xxx. Name: Grade (fall of 2014): Address: City: State: Zip: Home Phone: Parent E-mail: School: T-shirt size (circle one): YS YM YL S M L XL Insurance Company: Group or Policy #: If there a...
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PERMISSION TO SECURE TREATMENT. In the event of an emergency, Participant authorizes Loras College to secure any treatment deemed necessary from any licensed hospital, physician, and/ or medical personnel and agrees to be responsible for payment of any and all services rendered. Participant has read and fully understands this entire document and declares that all information supplied by Participant is accurate and current. 0000 Xxxx Xxxxx Xx. | Xxxxxxx, XX 00000-0000
Sample 1
PERMISSION TO SECURE TREATMENT. In the event of an emergency, Participant authorizes Loras College to secure any treatment deemed necessary from any licensed hospital, physician, and/ or medical personnel and agrees to be responsible for payment of any and all services rendered. Participant has read and fully understands this entire document and declares that all information supplied by Participant is accurate and current. ______________________________________________________ Participant’s Name(s) (please print) ____________________________________________________ Address Parent’s or Guardian’s Name (please print) ______________________________________________________ Relationship to Participant (If any Participant is a minor.) Participant Signature(s) Date (Must be signed by Parent or Guardian if any Participant is a minor.) ABOUT LORAS COLLEGE Historically rich, academically challenging, socially stimulating, faith-centered–that’s Loras College. Founded in 1839, Loras College is Iowa’s oldest college and the scenic 60-acre campus is nestled high atop the majestic bluffs of the Mississippi River in Dubuque, Iowa. Loras offers over 40 majors and 12 preprofessional programs. The student-to-faculty ratio is 13 to 1 for small class sizes with caring, energetic professors who xxxxxx learning. Loras recently added a January-Term – three weeks of extensive study oftentimes held off campus or abroad. Loras has many internships and study abroad opportunities also. All students receive multimedia Lenovo Thinkpad® Twist (hybrid laptop) computers, wired/wireless network access and technology support. 0000 Xxxx Xxxxx Xxxxxx | Xxxxxxx, XX 00000 Loras has over 70 organizations that cover a variety of interests including academic, athletic, recreational, honorary, leadership, media/ publications, performing arts, spiritual, student government and special interests; an intramural program with twice-weekly activities, 21 varsity sports; 11 service trips per year, spiritual opportunities for all faiths and many other activities and chances to be an active member of the Loras community. At Loras College, students get more out of their college experience than just honors and awards. With help from faculty, staff, coaches and the Loras Academic Success Center, students graduate to satisfying and rewarding careers.
Sample 1
PERMISSION TO SECURE TREATMENT. In the event of an emergency, Participant authorizes Loras College to secure any treatment deemed necessary from any licensed hospital, physician, and/ or medical personnel and agrees to be responsible for payment of any and all services rendered. Participant has read and fully understands this entire document and declares that all information supplied by Participant is accurate and current. 0000 Xxxx Xxxxx Xx. | Xxxxxxx, XX 00000 Participant Name(s) (please print): (Parent) (Child) Address: Participant Signature(s): Date: Baseball 19th Annual Winter Training Camp February 8, 2014 (Ages 12-18) February 15, 2014 (Ages 7-11) XXXXX.XXX Winter Training Camp Feb. 8 & 15, 2014 (Must be signed by Parent or Guardian if any Participant is a minor) Relationship to Participant (If any Participant is a minor): Dear Baseball Camper, Warm up the glove and the bat and get ready for another Loras Baseball Winter Training Camp! Our camp is a specialized program that provides you the opportunity to be assisted and evaluated by top coaches. Our goal is to improve your skill level and prepare you for the upcoming season. Loras Baseball Camps are unique in that my assistants and I demonstrate and teach a variety of skills and fundamentals necessary for participants to progress in America’s sport. In addition, a number of players from the Loras Baseball team will assist you in understanding key concepts and strategies needed on the diamond. Duhawk Baseball Camps are designed to give personalized instruction and individual attention to facilitate skill development. I hope to see you at the 19th Annual Loras College Winter Training Camp! Coach Xxxx Xxxxx Camp Objectives There will be two camps, based on the age of the camper. Both camps are designed to offer player focused, professional instruction in position play and hitting by means of instruction and development drills. Camp Sessions • February 8 – 12-18 year olds • February 15 – 7-11 year olds Schedule • Defense – 9:00 a.m.-12:00 noon • Lunch Break- 12:00 noon-1:00 p.m. (lunch on your own – not provided) • Offense – 1:00-3:00 p.m.
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PERMISSION TO SECURE TREATMENT. You authorize, for emergency purposes only, any designated employee of JLC Learning to consent to any necessary examination, anesthetic, medical diagnosis, surgery, or treatment, and/or hospital care to be rendered to you or to Minor (if any), and agree that you will be responsible for payment of any and all medical services required.
Sample 1
PERMISSION TO SECURE TREATMENT. In the event of an emergency, Participant authorizes Loras College to secure any treatment deemed necessary from any licensed hospital, physician, and/or medical personnel and agrees to be responsible for payment of any and all services rendered. Participant has read and fully understands this entire document and declares that all information supplied by Participant is accurate and current. Participant’s Name(s) (please print) ___________________________________________________________ Address ________________________________________________________ Parent’s or Guardian’s Name (please print) Relationship to Participant (If any Participant is a minor.) Participant Signature(s) Date (Must be signed by Parent or Guardian if any Participant is a minor.) ABOUT LORAS COLLEGE Loras College, as a Catholic, liberal arts college, creates a community of active learners, reflective thinkers, ethical decision- makers and responsible contributors in diverse professional, social and religious roles. Founded in 1839, Loras leverages its historic roots as Iowa’s first college and its position as one of only ten diocesan colleges in the nation, to deliver challenging, life changing experiences that make it the perfect place to prepare for a life you’ll love. BE MORE. BE LORAS. 0000 Xxxx Xxxxx Xxxxxx | Xxxxxxx, XX 00000-0000 COLLEGE PREP WEEKEND CAMP Integrating service into its culture, Loras has been appointed to the President’s Honor Roll for Service with Distinction every year, and received the first President’s Award for Interfaith Community Service in 2014. With nearly 40 majors and 13 pre- professional areas of study to choose from, the academic, cultural, spiritual and athletic experiences at Loras offer students wide opportunities to pursue their passions and create successful, rewarding careers and lives. Ranked 11th Best College among Midwest regional colleges by US News Media Group for ensuring academic rigor, and #6 Best Value, Loras consistently outperforms peer institutions in employment after graduation, with over 96% of graduates employed or enrolled in graduate school within twelve months of graduation. BE MORE. BE LORAS. 0000 Xxxx Xxxxx Xxxxxx | Xxxxxxx, XX 00000-4327 | 000-000-0000 BE MORE. BE LORAS. SOCCER COLLEGE PREP WEEKEND CAMP BOYS: JULY 31 - AUG. 1, 2015 GIRLS: JULY 31 - AUG. 1, 2015 Our Mission: To be the best small college in the country to play soccer. XXXXX.XXX SOCCER COLLEGE PREP WEEKEND CAMP Xxx Xxxxxxx – Camp Director and Head Soccer Coach a...
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Related to PERMISSION TO SECURE TREATMENT

  • Consent to Medical Treatment 1. I authorize the School District and my child’s custodian to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment or hospital care which is deemed advisable by and is rendered under the general supervision of any licensed physician or surgeon, whether such treatment or diagnosis is rendered at the office of such physician or at a hospital.

  • Consent to Transportation and Medical Treatment I consent to the use of first aid treatment and the use of generic and over-the-counter medications and treatments as directed by manufacturer labels, whether administered by the Released Parties or first aid personnel. In an emergency, I understand the Released Parties may try to contact the individual listed below as an emergency contact. If an emergency contact cannot be reached promptly, I hereby authorize the Released Parties to act as an agent for me to consent to any examination, testing, x-rays, medical, dental or surgical treatment for me as advised by a physician, dentist or other health care provider. This includes, but is not limited to, my assessment, evaluation, medical care and treatment, anesthesia, hospitalization, or other health care treatment or procedure as advised by a physician, dentist or other health care provider. I also authorize the Released Parties to arrange for transportation of me as deemed necessary and appropriate in their discretion. I, the Volunteer, do hereby release, forever discharge and hold harmless the Released Parties from any liability, claim, demand, and action whatsoever brought by me or on my behalf which arises or may hereafter arise on account of any transportation, first aid, assessment, care, treatment, response or service rendered in connection with my Activities with any of the Released Parties. If the Volunteer is less than 18 years of age, the parent(s) having legal custody and/or the legal guardian(s) of the Volunteer also hereby release, forever discharge and hold harmless the Released Parties from any liability, claim, demand and action whatsoever brought by such volunteer or on his/her behalf which arises or may hereafter arise on account of the decision by any representative or agent of the Released Parties to exercise the power to transport, administer first aid, and consent to assessment, examination, x-rays, medical, dental, surgical or other such health care treatment as set forth in the Parental Authorization for Treatment of, and Travel With, a Minor Child.

  • Consent to Treatment The Boys Town Behavioral Health Clinic works with children and their families to identify and treat such issues as depression, anxiety, school problems, and ADHD. The Behavioral Health Clinic offers specialized services, including behavioral and psychological assessments as well as counseling. I, knowing that the client has a condition requiring diagnosis and treatment, do hereby voluntarily consent to such treatment by the Behavioral Health Clinic staff, assistants, or designees as is, in their judgment, necessary. I further acknowledge that no guarantees have been made to me as to the results of treatment. I authorize you to provide reasonable and proper care by today’s standards. If applicable, I have informed my treating provider of my mental health advance directives and have provided a copy for mental health decision-making that will become part of my treatment record. CONTACT BY TELEPHONE and EMAIL‌

  • Xxx Treatment We have not promised you any particular tax outcome from buying or holding the Note.

  • Emergency Medical Treatment I grant the Releasees permission to authorize emergency medical treatment as they deem appropriate, and agree that such action by the Releasees shall be subject to the terms of this Agreement. I understand and agree that the Releasees assume no responsibility for any injury or damage that might result from such emergency medical treatment.

  • General Treatment 1. Each Contracting Party shall in its Area accord to investments of investors of the other Contracting Party treatment in accordance with international law, including fair and equitable treatment and full protection and security.

  • National Treatment and Most-favoured-nation Treatment (1) Each Contracting Party shall accord to investments of investors of the other Contracting Party, treatment which shall not be less favourable than that accorded either to investments of its own or investments of investors of any third State.

  • Public Posting of Approved Users’ Research Use Statement The PI agrees that information about themselves and the approved research use will be posted publicly on the dbGaP website. The information includes the PI’s name and Requester, project name, Research Use Statement, and a Non-Technical Summary of the Research Use Statement. In addition, and if applicable, this information may include the Cloud Computing Use Statement and name of the CSP or PCS. Citations of publications resulting from the use of controlled-access datasets obtained through this DAR may also be posted on the dbGaP website.

  • Fair Treatment The College and the Union agree that there shall be no discrimination, restriction, or coercion exercised or practised with respect to any employee for reason of membership or activity in the Union.

  • Denial of Preferential Tariff Treatment The Customs Authority of the importing Party may deny a claim for preferential tariff treatment when:

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