Medical Release and Authorization
As Parent and/or Guardian of the named student, if said student is at a Central Creativity or partner organization location (in-person or remote), 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, 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, or x-ray examination for the named student. 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 Central Creativity and its partner organizations, as well as their affiliates including Directors, teachers, mentors, and volunteer parents to contact medical professionals and request medical care be sent to the physical location of any camper who is non-responsive or seems to be in medical distress. Permission is granted to authorize said emergency personnel to perform the needed emergency treatment prior to the child’s admission to the medical facility.
This release is authorized on the dates and/or duration of the registered camp.
By clicking the NEXT button below and completing the ordering process, I acknowledge that this 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 child, in my absence.