Subject to the conditions set below, I authorize the Lutheran Volunteer Corps Staff to seek such medical treatment and/or surgical procedures as are deemed necessary in the event of an emergency. I assume liability for any medical expenses involved as outlined in the 3-Way Contract and the Health Insurance Wavier. Lutheran Volunteer Corps staff may also use this emergency contact information in medical and other emergency situations. This authorization extends to my participation in any activity sponsored by the Lutheran Volunteer Corps.
Should a medical emergency arise during my participation in a Lutheran Volunteer Corps sponsored activity which will adversely affect my life or health, and I am unable to speak on my own behalf, I consent to:
the administration of medical treatment and/or surgical procedures deemed necessary by the medical doctor and/or medical facility identified below or chosen by the Lutheran Volunteer Corps Staff; and
the immediate administration of life-sustaining measures deemed necessary under the circumstances.
Please submit this form by June 1, 2017.