Medical Release and Authorization
As Parent and/or Guardian of the named participant (or participant representing yourself if over 18 without a legal guardian), 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 the emergency contact person in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach the emergency contact person.
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 participant, in my absence.