Medical Release and Authorization
As Parent and/or Guardian of the named participant in CYIA activities, 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.
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 CEF of Iowa to provide the needed emergency treatment prior to the child’s admission to the medical facility.
This release is authorized for the year in which it is filled out.