Emergency Medical Release (*Must be initialed for your child to participate) My indicating yes indicates that in the event of an emergency and in the event that: (1) a parent/ legal guardian or the authorized/ designated individual(s) cannot be reached; or (2) immediate medical attention is necessary, I consent to have Girls Group staff/ leaders/ volunteers act in my behalf and hereby grant my permission for emergency treatment to be administered until a parent/ legal guardian or the authorized/ designated individual(s) identified can be reached. I am consenting to any X-ray examinations, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care, to be rendered to the minor under general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to his/her authorization. I agree not to hold Girls Group or any staff/ leaders/ volunteers liable for any decisions, for any medical treatment made under this authorization or for any accident or loss to the student, however caused.