Medical Release and Authorization
As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, 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.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. 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 attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.
Permission is also granted to the Rodney Hoops and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.
Release authorized on the dates and/or duration of the registered season.
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, in my absence.
COVID-19 is highly contagious and is known to spread mainly from person-to-person contact. By attending group meetings at Rodney Hoops/Michiana Christian Embassy, you agree to abide by the procedures established by the Rodney Hoops staff, including wearing a mask & social distancing to sign in. You agree that you voluntarily assume the risk that you and/or your family may be exposed to or infected by COVID-19 at the Rodney Hoops/ Michiana Christian Embassy and you waive any liability against Rodney Hoops/ the church and any other parties. You also acknowledge that for all future events/meetings that you attend, you will self-check the above questions & recommendations and follow the guidelines.
I grant permission and give my consent for Harbor Impact/Rodney Hoops to use any photos or videos of my child taken during training sessions and games for their website and social media platforms.