Common Contracts
2 similar Parental Consent and Waiver Agreement contracts
PARENTAL CONSENT FOR TREATMENT OF MINORSParental Consent and Waiver Agreement • May 29th, 2024
I, as the parent or legal guardian of a minor, hereby authorize a representative of IYRF, or Rugby Indiana, or Select Physical Therapy to seek medical and/or surgical treatment for my son/daughter as may be deemed medically necessary in order to assure his/her safety. It is distinctly agreed and understood that the representative of IYRF, Rugby Indiana, Select Physical Therapy shall not be responsible in any way for any consequences from said diagnostic, medical and/or surgical treatment.
PARENTAL CONSENT FOR TREATMENT OF MINORSParental Consent and Waiver Agreement • February 7th, 2023
I, as the parent or legal guardian of a minor, hereby authorize a representative of IYRF, or Rugby Indiana, or Select Physical Therapy to seek medical and/or surgical treatment for my son/daughter as may be deemed medically necessary in order to assure his/her safety. It is distinctly agreed and understood that the representative of IYRF, Rugby Indiana, Select Physical Therapy shall not be responsible in any way for any consequences from said diagnostic, medical and/or surgical treatment.
