Emergency Contact Information (Required)

Authorization to Consent to Treatment of Minor
Important: This permission slip is due the day of the event.

Your child(ren) may not attend the event without it. (I)(We), the undersigned, parent(s) of 

, a minor, do hereby authorize the Youth Director, or his authorized representative, as agent(s) for the undersigned, to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is rendered under the general or special supervision of any physician and/or surgeon licensed under the provision of the California Medicine Practice Act or the medical staff of a licensed hospital, whether such examination, diagnosis, or treatment is rendered at the office of said physician or at such hospital. It is understood that this authorization is given in advance of any specific examination, diagnosis, treatment, or hospital care being required and is given to provide authority and power on the part of the Youth Advisor, or his/her authorized representative, to give specific consent to any and all such examinations, diagnoses, treatment or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable. This authorization is given pursuant to the provisions of section 25.8 of the Civil Code of California. This authorization shall remain effective until the end of the current youth group event.