Medical Treatment Authorization. As the parent/guardian of (please print student’s name), a student participating in the Global Youth Leadership Institute, I authorize physicians and/or other medical personnel, at the direction of GYLI or my child’s/xxxx’x chaperone to provide medical care to my child/xxxx while he/she is away from home and participating in the GYLI, including examining, treating and prescribing medications for her/his care. I understand that the faculty and staff and/or the chaperone will, to the greatest extent possible, consult with me concerning the reasons for and effects of all such care. Recognizing that it may be impossible to reach me in situations in which the physicians treating my child/xxxx believe that beginning treatment is medically necessary, I authorize GYLI or the chaperone to permit commencement of treatment when, in the professional judgment of the physicians or medical personnel involved, such treatment is medically necessary, even if I/we have not yet been consulted. In authorizing such emergency treatment, I agree to accept the determination of the treating physician or surgeon that the treatment or examination rendered was medically necessary to protect the life, health or mental well-being of my child/xxxx. I give this authorization on the condition that the treating physician will attempt to contact me, if at all possible, before the treatment or examination is rendered. Signature of Parent/Guardian Date
Medical Treatment Authorization. Permission is hereby granted for any chaperone, any of the Organizers’ staff, or adult present or in charge of first aid, to authorize and to obtain medical attention, hospitalization, or medication in case of sickness or injury to Participant. By signing below, undersigned acknowledges that the Organizers have undersigned’s permission to make all medical/dental/surgical decisions regarding health care emergencies and to provide for medical care for Participant during the Event. The undersigned hereby accepts any and all financial obligations incurred as a result of such immediate medical treatment, and subsequent related costs.
Medical Treatment Authorization. In the event of illness and/or injury, I (parent/legal guardian named below) do hereby consent to whatever medical or dental diagnosis and/or examination, emergency care and/or transportation to hospital or clinic, treatment, x-rays, anesthetic, or surgical care is considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services for my son/daughter/xxxx.
Medical Treatment Authorization. I consent to allow Oakwood School to administer first aid or to authorize medical care for my child in its sole discretion. This authorization is given pursuant to Section 6910 of the California Family Code and is intended to be effective both within and without the State of California.
Medical Treatment Authorization. In the event of an injury or illness, I give permission for my child, to be treated by a qualified athletics trainer, nurse or licensed EMT and/or emergency room staff at the local hospital. (signature of parent or guardian) (date) I agree that my child must turn in his/her car keys, if applicable, to camp staff at check-in if driving himself/herself to camp. I agree, on behalf of myself, my child, and our assigns, executors, and heirs, to indemnify, and hold harmless, Oswego State and its trustees, officers, agents and employees from any and all liability, damage and claims of any nature arising out of or in any way related to my child’s participation in this program except those things caused by the sole negligence of Oswego State. (parent or guardian please PRINT name here) (date) (signature of parent or guardian) A photocopy of your child's Record of Immunizations must be obtained from your physician and submitted on the physician’s stationary. PLEASE RETURN ALL FORMS TO: Oswego State Summer Athletic Camps SUNY Oswego Laker Hall Oswego, NY 00000-0000
Medical Treatment Authorization a. I acknowledge that I have consulted with a medical doctor regarding personal medical needs and there are no physical or mental health-related reasons to preclude participation from the PROGRAM.
Medical Treatment Authorization. As the parent(s)/guardian(s) of (please print name of student), a student participating in the Trailblazers Yosemite 2017 trip, I am aware that no medical personnel will be attending the trip. Therefore, I authorize physicians and/or other medical personnel to provide medical care to my child while he/she is away from home and participating in the Trailblazers Yosemite 2017 trip, including examining, treating and prescribing medications for their care. I understand that the physicians and/or other medical personnel on location will, to the greatest extent possible, consult with me concerning the reasons for and effects of all such care. Recognizing that it may be impossible to reach me in situations in which the physicians treating my child believe that beginning treatment is medically necessary, I authorize commencement of treatment when, in the professional judgment of the physicians and/or other medical personnel involved, such treatment is medically necessary, even if I/we have not yet been consulted. In authorizing such emergency treatment, I agree to accept the determination of the treating physician or surgeon that the treatment or examination rendered was medically necessary to protect the life, health or mental well-being of my child. Print Full Name of Parent/Guardian #1 Parent/Guardian #1 Signature Date Parent/Guardian #1 Phone Parent/Guardian #1 Email Print Full Name of Parent/Guardian #2 (if none please write “none”) Parent/Guardian #2 Signature Date Parent/Guardian #2 Phone Parent/Guardian #2 Email STUDENT NAME HEALTH & MEDICAL Supplement When a student applies for a program, the Director of Global Education will consult his/her Pingry school medical records. The following supplementary questions will help us keep the student safe and healthy and ensure the program is appropriate.
Medical Treatment Authorization. I grant the University permission to authorize emergency medical treatment as it deems appropriate, and agree that such action by the University shall be subject to the terms of this agreement. I understand and agree that the University assumes no responsibility for any injury or damage that might arise out of or in connection with such authorized emergency medical treatment.
Medical Treatment Authorization. In the event Minor becomes injured or ill while at the YMCA facilities and/or participating in the Childcare Activities, I/we authorize the Released Parties to secure first aid and/or the services of any legally qualified physician or hospital for Minor and I/we agree to assume any financial obligations incurred therewith.
Medical Treatment Authorization. I authorize and give my consent to the Academy to act on my behalf, or on behalf of my child (who is under 18), in any medical emergency, including, if necessary, emergency medical treatment and admission to an accredited hospital or emergency care center. I understand and acknowledge that the Academy does not provide health and accident insurance for the Program participants, and I agree to be financially responsible for any medical bills incurred as a result of medical treatment rendered to me (or to my child).
