Point of contact for Northmont: Steph Martin (804-614-5515)Point of contact for Tarentum: Del Treese (412-608-0781)Point of contact for Hiland: Chad Johnson (412-760-4228)Point of contact for Wexford: Mike Barton (724-272-5786)
STATEMENT OF CONSENT:I hereby consent to participation by my child, in the event described above. I understand that this event will take place away from Northmont and that my child will be under the supervision of the designated staff person on the stated dates. I further consent to the conditions stated above on participation in this event, including the method of transportation.
We (I) authorize an adult, in whose care the minor has been entrusted, to authorize any emergency medical/dental care deemed necessary by any physician or dentist licensed under the Medical Practice Act, on the medical staff of a licensed hospital.
The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical/dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my) child to return home due to medical OR disciplinary reasons, the undersigned shall assume all transportation costs.