The undersigned, in my capacity as parent or legal guardian, hereby acknowledge the health risks and dangers associated with the transmission of the COVID-19 virus, and other communicable diseases, and recognize that exposure to the COVID-19 virus, or other communicable diseases, could occur while my child is participating in Rc3 programs.
I authorize RC3 to obtain immediate medical care and consent to the hospitalization of, the performance of necessary diagnostic test upon, the use of surgery on, and/or the administration of drugs to myself if an emergency occurs when emergency contact cannot be located immediately. It is also understood that this agreement covers only those situations which are true emergencies and only when he/she cannot be reached. I understand that the provider will make every effort to contact my designated emergency contact.
Please complete the following:
1. I/we will be responsible for payment of medical expenses.
2. Medical treatment costs are covered by: