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Minor Medical Authorization Form

  • Monday, February 05, 2024 2:19 PM
    Message # 13310913

    If you have a program that involves persons under 18, do you require a form signed by the parent/guardian to allow medical treatment if necessary?

  • Tuesday, February 06, 2024 10:22 AM
    Reply # 13311331 on 13310913

    Yes. I attached the form we use. Thanks, Nancy

    1 file
  • Tuesday, February 06, 2024 3:52 PM
    Reply # 13311535 on 13310913
    Sara Camic (Administrator)

    Yes, we do. I pulled the verbiage from our form and it's below: 


    In the event of an accident or serious illness, I hereby authorize representatives of UK to obtain medical treatment for my Child on my behalf. I hereby hold harmless and agree to indemnify UK from any claims, causes of action, damages and/or liabilities, arising out of or resulting from said medical treatment. I further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries to my Child that may occur during his/her participation in the Program.

    This RELEASE contains the entire agreement between the parties to this agreement and the terms of this RELEASE are contractual and not a mere recital. The information I have provided is disclosed accurately and truthfully. I have been given ample opportunity to read this document and I understand and agree to all of its terms and conditions. I understand that I am giving up substantial rights (including my right to sue), and acknowledge that I am signing this document freely and voluntarily, and intend by my signature to provide a complete and unconditional release of all liability to the greatest extent allowed by law. My signature on this document is intended to bind not only myself and my Child but also the successors, heirs, representatives, administrators, and assigns of myself and my Child.


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