EmergencY Medical Information
Consent to Medical Treatment: The undersigned parent/guardian authorizes the Rockford Rowing Club or any of its representatives who have an original or copy of this document to consent, on behalf of the rower, to any x-ray, anesthetic, medical or surgical diagnossis or treatment and hospital care that is deemed advisable by, and is to be rendered under the general or specific supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act of the laws of the state or country in which the medical care is being sought.
The parent/guardian understands that this authorization is given in advance of any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment or hospital care being required and is given to provide authority and power on the part of the Rockford Rowing Club to give specific consent to any such examination or treatment which, in the exercise of best judgment, is deemed advisable. Neither Rockford Rowing Club, nor any organization involved assumes any financial responssiblitly for exercising this action. This authorization is given voluntarily with full knowledge of its significance. I have read and understand all of its terms.
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