Medical Consent. Participant grants permission to Cedar Springs Camp and its employees and agents to take the Participant to a licensed physician for medical treatment, emergency surgery, or hospitalization if Participant becomes ill, sustains an injury, or otherwise requires medical treatment or attention and Cedar Springs Camp is unable to contact the Emergency Contact listed by Participant. The Participant gives consent to any licensed physician to administer drugs or medicine or to perform such medical procedures as that physician determines necessary for the relief of pain and to preserve the Participant's life or health. Participant further authorizes Cedar Springs Camp to give first aid, CPR or other treatment by a qualified staff member to Participant.
Medical Consent. I agree that if I suffer any injury, damage or loss to my person, I will submit to medical treatment in accordance with the recommendation of the Medical Officer.
Medical Consent. In case of any medical emergency (physical or mental) occurring during my participation in this Program, I hereby grant to District or any of its representatives of the Program the full authority to take any action deemed necessary to protect my mental or physical health and safety, including but not limited to, placing me under the care of a doctor or in a hospital or any place for medical examination and/or treatment, including the administration of an anesthetic and surgery, or returning me to the United States at my own expense if such return is deemed necessary after consultation with medical authorities. I agree that District is not obligated to attend to any of my medical or medication needs, and I assume all risk and responsibility therefore. I further agree District is not required to take any such actions if it is not aware of any emergency or in its discretion determines no emergency exists. Should the need arise District is authorized to provide any of my personal information to any health care provider. I agree to complete and provide District a Emergency Contact Information form attached hereto as Exhibit B and incorporated herein by reference. I understand that I may be required to pay up front for any such treatment that I incur while traveling and in the host county. I agree to assume all costs related to any such treatment and release District from any liability for any actions.
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
Medical Consent. I grant PNKF permission to call 911 for emergency medical aid or to take me to a physician or hospital for medical treatment, or both, if any PNKF agent or volunteer believes Applicant requires medical treatment. I assume all responsibility for all medical, rescue, transportation, and other expenses incurred on Applicant’s behalf.
Medical Consent. I, the undersigned patient or legal representative, consent to the general treatment and procedures that may be performed. These procedures may include but are not limited to laboratory procedures, x-ray examinations, medical or surgical treatment or procedures provided to the patient under the general and special instructions of the patient’s physician or surgeon. I understand that it is the responsibility of the patient’s physician to obtain the patient’s informed consent when required for specific medical or surgical treatment and special diagnostic or therapeutic procedures. I understand and agree that at the request of the attending physician, health practitioners (such as physician assistants and nurse practitioners) may participate in the patient’s care.
Medical Consent. In the event I am injured or become physically or mentally ill during my participation in The Program, I hereby authorize UCLA and its representatives to obtain, at my sole cost and expense, such medical care as may be needed to protect my physical and mental health. In the event I am unable to do so myself, I hereby also authorize UCLA and its representatives to provide consent on my behalf for such medical treatment, including, but not limited to, placing me under the care of a doctor or in a hospital or any place for medical examination and/or treatment or returning me to the country of residence at my own expense if such return is deemed necessary after consultation with medical authorities. In the event I am returned to the United States, I agree I shall not recover any money paid for and in connection with the Program. I agree that UCLA is not required to take any such actions if it is not aware of any emergency or in its discretion determines no emergency exists. Should the need arise, UCLA is authorized to provide any personal information about me to any health care provider. I have read, understand and agree.
Medical Consent. Participant grants permission to The Edge Christian Camp and its employees and staff to take the participant to a licensed physician for medical treatment, emergency surgery, or hospitalization if participant becomes ill, sustains an injury, or otherwise requires medical treatment or attention and The Edge Xxxxxxxxx Xxxx is unable to contact the emergency contact listed by participant. The participant gives consent to any licensed physician to administer drugs or medicine, or to perform such medical procedures as that physician determines necessary for the relief of pain and to preserve the participant’s life or health. Participant further authorizes The Edge Christian Camp to give first aid, CPR, or other treatment by a qualified staff member to participant.
Medical Consent. I give permission in the case of injury or similar emergency involving me and/or my minor child/xxxx for AGC to administer CPR or first aid. In the event that I and/or said minor requires medical attention, I hereby consent to any x- rays, medical treatment or diagnosis or hospital care to be rendered under the supervision of duly licensed physicians, dentists and/or paramedics. I understand that this medical authorization is being given in advance of any specific injury or illness.
Medical Consent. If medical attention, beyond first-aid treatment, is required, I understand that an attempt will be made to contact me at the phone number I provide below. If contact with me is not made, I give permission for medical attention to be administered and my medical insurance to be contacted, as shown below.
