Parent/Guardian Consent to Treat a Minor
I, being the parent or legal guardian of the minor named below, do consent to any x-ray, anesthetic, medical, surgical, or dental diagnosis or treatment that may be deemed necessary for my minor child. I understand that all efforts will be made to contact me prior to treatment. In the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no leader available, I give permission to the attending physician to treat my minor child with the understanding that all of the providers attending to my child will take all reasonable safety precautions during their care.
Further, as parent or legal guardian, I am responsible for the health care decisions for my minor child and agree that my insurance plan is the primary plan to pay for the dental, medical, or hospital care or treatment that is given to my child. Any policy of the churches or organizations sponsoring this event will be used as the secondary coverage.