Medical Release and Authorization
I attest that the participant is in good health and has no physical, mental, or emotional reason that would prohibit them from participating in the event. I understand that every precaution has been taken to assure the good health and safety of all participants.
As Parent and/or Guardian of the named participant, 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, 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 me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.
I understand that CB/GEC does not provide medical insurance for the cost of any required treatments and that all expenses would be the responsibility of the family of the participant requiring treatment.
Permission is also granted to CB/GEC and its representatives to provide the needed emergency treatment prior to the participant's admission to the medical facility.
Release authorized on the dates and/or duration of the registered event.
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 participant, in my absence.