Emergency Treatment Authorization
I, the parent or legal guardian of the the above-name student, do hereby consent to x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital service that may be rendered to said student under the general and special instruction of the below-name physician or any physician the school may call, whether such diagnosis or treatment is rendered at the physician's office or a licensed hospital. It is understood that reasonable effort will be made to contact the doctor below before caling another physician. It is further understood that this consent is given in advance to autherize Glendale Adventist Academy or the physician to exercise their best judgment regarding the requirements of diagnosis or treatment. This consent shall remain in continuous effect until revoked in writing and delivered to the school entrusted with the custody of the said student.
We, hereby, authorize any hospital, physician, or another person who has attended or examined the minor to furnish to the insurance company handling the student insurance or its representative any information with respect to any illness, medical history, consultation, prescriptions or treatment, and copies of all hospital or medical records. A copy of this authorization shall be as effective and valid as the original.
