AUTHORIZATION TO CONSENT TO TREATMENT
I recognize that there are risks involved in participating in the event listed above and hereby assume all risk of injury in connection with my child’s participation in it. I understand and agree that neither Calvary Homestead nor its trustees, officers, directors, employees, agents or representatives may be held liable in any way for any injury that may occur to me as a result of my child’s participation in this event and hereby release Calvary Homestead, its trustees, officers, directors, employees, agents and representatives from any injury which may occur while my child is participating in this event. To the fullest extent permitted by law, I agree to save and hold harmless Calvary Homestead, its trustees, officers, directors, employees, agents and representatives from any claim by myself, my estate, heirs, successors, assigns or other persons arising out of my child’s participation in this event.
I authorize Calvary Homestead through its trustees, officers, directors, employees, agents or representatives to render or obtain such emergency medical care or treatment for my child as may be necessary should any injury, harm or accident occur to my child while participating in this event.
I as parent(s)/Guardians(s) of the child named above on this consent form, do hereby authorize Calvary Homestead, it’s staff or representatives, as agent(s) for the undersigned to consent to a X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care that is deemed advisable by, and is to be rendered under the general supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act on the medical staff of any hospital or medical clinic whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment of hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable. The authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California (allows Parent(s) or Guardian(s) to authorize any adult to consent to medical or dental treatment as stated in the above paragraphs). This authorization shall remain effective from June 18th, 2026 through June 20th, 2026 unless sooner revoked in writing delivered to said agent(s).