We at All Nations will do our best to provide a safe and supervised environment during our children’s activities. However, in case of an emergency, we ask that you sign this release in order to provide the best possible treatment for your child.
As a parent/guardian, I do herewith authorize treatment under direction of any licensed physician of this child in the event of a medical emergency, which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me by phone at the number(s) listed. I assume responsibility for any costs connected with such treatment and hereby release ANBC from any liability therefore.
This release form is completed and signed of my own free will and with the sole purpose of authorizing treatment under emergency circumstances in my absence.