TRC Medical Treatment Authorization and Consent

The following is designed for those situations where minors are unaccompanied by either a parent or legal guardian.

This “ Medical Treatment Authorization and Consent” gives authority to a designated adult to arrange for medical care for a minor in the event of an emergency. This is extremely important, in that, medical care cannot be provided to a minor without approval by the parents or legal guardians, unless there is written authorizing an agent to give approval:

The undersigned do hereby authorize the Thunder Ridge Composite Team/Coach/Team Director or such substitute as he/she may designate as agent for the Undersigned to consent to any X-ray, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care for the above named minor which is deemed advisable by and to be rendered under the general or special supervision of any physician and/or surgeon, licensed under the Provision of Medicine Practice Act or of any dentist licensed under the Dental Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or dentist, at a hospital, or elsewhere.

Parent / Guardian Electronic Signature below: