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.
Permission is also granted to the Gentle
Giant Acres and its affiliates including Directors, Coaches, and Team Parents
to provide the needed emergency treatment prior to the child’s admission to the
medical facility.
Release authorized on the dates and/or
duration of the registered season.
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
minor child, in my absence.