Medical Release and Authorization
I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional 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 participant'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 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 attending physician to contact nearest of kin/friends in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach the participant's next of kin/friends.
Permission is also granted to the The Real Distraction Show and its affiliates including Directors, Producers, Film Crew, Host(s), participants, and audience member(s) to provide the needed emergency treatment prior to the admission to the medical facility.
Release authorized on the dates and/or duration of the filming sessions.
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 my life and limb.