TO GRANT CONSENT Sample Clauses

TO GRANT CONSENT. In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by above named doctors, or in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists concurring in the necessity for such surgery are obtained prior to the performance of such surgery. Signature of Parent/Guardian Date

TO GRANT CONSENT. In case of an emergency involving the above-named student, Shorin Ryu Karate Academy, LLC will make reasonable attempts to contact the following: NAME TELEPHONE Parent/Guardian: 1. / Parent/Guardian: 2. / Nearest Relative: 1. / Nearest Relative: 2. / In the event that reasonable attempts were made to contact the parent, guardian, or nearest relative listed above, I hereby give my consent for the administration of any treatment deemed necessary by: NAME TELEPHONE Family Physician: / Family Dentist: / In the event that the designated preferred physician is not available, I hereby give consent for treatment by any licensed physician or dentist. I hereby give consent to allow my child to be transferred by emergency medical services to or any hospital reasonably accessible. [See additional authorization on next page.] This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery are obtained before the surgery is performed. Facts concerning the child’s medical history, including allergies, medications being taken and/or any physical impairments to which a physician should be alerted are as follows: . Signature of Parent / Guardian Date Printed Name of Parent / Guardian