Medical Release and Authorization - All Children Registered
As Parent and/or Guardian of the named participants who are minors, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor children, 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 participants. 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 Rocky Mountain Helath and Exercise, LLC, and its affiliates including Exercise Physiologists and helpers, to provide the needed emergency treatment prior to any of my children’s admission to the medical facility.
Release authorized on the dates and/or duration of the registered program May 28, 2024 until August 1, 2024.
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 children, in my absence.