This health history is correct as far as I know, and the person herein described has permission to engage in all prescribed activities except as noted by the examining physician and me. In the event that I cannot be reached in an emergency, I hereby give permission to the medical professional selected by the Pilgrimage staff to hospitalize, secure proper treatment, or order injection, anesthesia or surgery for the participant as named above.
Disclaimer: By signing this document you understand that reasonable accommodations are made in an effort to create an inclusive environment. Pilgrimage reserves the right to deny or revoke acceptance, in its sole discretion, at any point and additional costs/ fees may apply. Reasonable accommodations are not always possible in all experiences, environments, or circumstances. Contact us for details or with questions regarding your situation.