Authorization & Liability
Authorization For Emergency Care To Minors (Under 18)
COMPLETE EVEN IF PARENT/LEGAL GUARDIAN WILL BE IN ATTENDANCE AT JUNIOR NATIONAL:
To be completed by parent or legal guardian.
I, the undersigned parent or legal guardian of the minor listed, do hereby authorize any X-ray, examination, anesthetic, dental, medical or surgical diagnosis or treatment by any physician or dentist licensed by the state and hospital service that may be rendered to said minor under the general, specific or special consent of:
The temporary custodian of the minor(s); whether such diagnosis or treatment is rendered at the office of the physician or dentist, or at a hospital licensed by the state, I authorize the physician or dentist to call in any necessary consultant at his discretion. I further authorize said physician or dentist to exercise his discretion in authorizing the disposal of any severed tissue or member. It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage the temporary custodian of the minor(s), and said physician or dentist to exercise their best judgment as to the requirements of such diagnosis or medical or dental treatment.
List known allergies of minor:
This consent shall remain effective until Midnight on June 26, 2021, unless sooner resolved in writing, delivered to said physician or dentist or said person instructed with the custody, care and control of said minor child or children.
In case of emergency, please provide phone numbers of people who should be contacted:
To be completed by all participants
I verify that I have read the rules, regulations, and Agreement of Responsibility and Liability
including the COVID-19 statement, related to participating and exhibition in the American-International Junior Charolais Association Junior National event and agree to adhere to all the rules and regulations accordingly.