Hold Harmless Authorization for Pediatric Emergency Medical and/or Surgical Treatment
For the safety of Children, sound medical practice calls for this authorization. In emergencies, where the Parent/Legal Guardian or Emergency Contact of the Child cannot be reached - this form will be extremely important. The authorization granted by this form will be used only when absolutely necessary and only after every attempt has been made first to contact the Parent/Legal Guardian or Emergency Contact.
I hereby give my permission for my Child to attend CJ’S Legacy “Camp”. The Child herein described has permission to engage in all prescribed camp activities except as noted.
I hold harmless CJ’S Legacy, and/or Education Leads To Success Foundation, and their employees, agents, servants and volunteers from all risk, liability, injury, damage and loss to all persons and property which may occur to my child during or resulting from participation in the program.
I hereby authorize CJ’S Legacy, and/or Education Leads To Success Foundation to take measures in the event of a medical emergency. I hereby give permission to the medical personnel selected by CJ’S Legacy, and/or Education Leads To Success Foundation to order X-rays, routine tests, treatment, and necessary related transportation for my child.
In the event I cannot be reached in an emergency, I hereby give permission to the Physician of the hospital selected by CJ’S Legacy, and/or Education Leads To Success Foundation to secure treatment, including hospitalization, for my Child as named above.