Consent for Emergency Treatment. I authorize the University of Wisconsin-Whitewater and its designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I agree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization. Signature: Date: Signature of Parent or Guardian (If Participant is under 18*): Date: *If your son, daughter or xxxx will be under 18 while participating, it is our policy to request your agreement to the above terms on behalf of your minor son, daughter or xxxx.
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Samples: www.uww.edu, www.uww.edu, www.uww.edu
