Medical Authorization and Consent. I grant my authorization and consent to administer general first aid treatment for any minor injuries or illnesses experienced by the Participant/Guest. If the injury or illness is life threatening or in need of emergency treatment, I hereby grant my permission to the Sponsors and their employees, as my attorney-in-fact, to have the power to undertake or cause to be undertaken medical treatment or procedures, including but not limited to the summoning of any and all professional emergency personnel to attend, transport (via ambulance or helicopter), and treat the Participant/Guest as necessary for any injury or health problem of any nature, including but not limited to undertaking or causing the undertaking of any life saving measures, and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the Sponsors medical or training personnel in the exercise of their best judgment upon the advice of any such medical or emergency personnel. I further agree that as parent or guardian of the Participant/Guest, I will be responsible either through medical insurance and/or personally for all costs associated with any medical treatment that may be required and that the Sponsors shall have no obligation to pay any of the associated medical costs. Initial here:
Medical Authorization and Consent. (initial) I, , having actual knowledge and conscious appreciation of the possibility of accident, illness, or injury to my person as a part of my participation in FSUIGP, do hereby consent and authorize The Florida State University International Programs As- sociation, Inc. and the FSU International Programs Association, UK., acting by and through the Florida State Univer- sity Board of Trustees, the Florida Board of Governors, its agents, faculty, and employees involved in and working with the international Study Program, full authority in the event of an accident, illness, or injury to my person, to take whatever measures and action they consider necessary and warranted under the circumstances to protect, safeguard, and minimize further injury to my health and safety. I understand such actions may involve or require placing me in a hospital within or outside my country of residence for medical services and treatment, or, if no hospital is read- ily available, to place me in the care of a local physician for treatment. If deemed necessary or desirable, I authorize said University officials, faculty, and employees to transport me to my country of residence by commercial airline or otherwise for medical treatment. I further agree any and all expenses incurred in rendering these services, whether placing me in a hospital, in the care of a physician, or transportation by commercial airline or otherwise, will be a debt and liability I am responsible for, and I agree to make immediate repayment, time being of the essence. (initial) I have clearly indicated on my Medical Self-Report Form any medical treatment, long-term disability, chronic illness and/or psychiatric treatment that I have received or am currently receiving. I recognize I may be asked to provide the treating physician’s written clearance for participation on the program. FINALLY, I HEREBY declare and represent in making, executing, and rendering this Agreement to Comply with FSU Rules and host country laws, Consent and General Release, and Waiver of Liability and Statement of Voluntary Medi- cal Authorization, I fully understand and acknowledge by my signature I am relying wholly upon my own judgment, belief, and knowledge of the circumstances involved in my participation and enrollment in FSU International Gateway Program. I have read this statement, understood its contents, and execute it of my own free will and choice.
