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 that, 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 granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination, and immunizations for the named athlete. In an emergency arising from a severe illness, the need for major surgery, or a significant accidental injury, I understand that the attending physician will make every attempt to contact me expeditiously. This authorization is granted only after a reasonable effort has been made to reach me.
Permission is also granted to the West Park Preparatory School and its affiliates, including Directors, Coaches, and Team Parents, to provide emergency treatment before 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.