Medical Release and Authorization
As Parent and/or Guardian of the named child(ren), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child(ren), in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the responsible chaperones to contact me in the most expeditious way possible. Permission is hereby granted to the attending physician only after a reasonable effort has been made to reach me.
Permission is also granted to the Cordoba Academy and its organizers including Supervisors, Volunteers, and Team Chaperones to provide the needed emergency treatment prior to the child(ren)’s admission to the medical facility.
Release authorized on the dates and/or duration of the registered camp.
This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child(ren), in my absence.