Medical Release and Authorization
As the Parent and/or Guardian of the child, in the event of any medical emergency, I authorize and consent for Emmons Summer Park & Rec. Program to act on behalf for medical care deemed necessary for the participant.
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 staff to contact you in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach the Parent and/or Guardian and the Emergency contacts listed above.
Permission is also granted to Emmons Summer Park & Rec. Program staff 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 the life and limb of the named minor child, in my absence.