Consent to Treat a Minor I, the undersigned parent or guardian of _____________________________, do hereby authorize the staff of Cypress Independent Colorguards to obtain medical treatment by a licensed physician/surgeon at an office or hospital for my child. After treatment of the above mentioned minor his/her custody shall be returned to the Cypress Independent staff if I am not available. The undersigned parent and natural guardian does herby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the Waiver of Liability and Hold Harmless Agreement set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian. Parent/Guardian Signature: ________________________________________________ Date: ______/______/___________
Consent to Treat a Minor I, the undersigned parent or guardian of _____________________________, do hereby authorize the staff of Cypress Independent Colorguards to obtain medical treatment by a licensed physician/surgeon at an office or hospital for my child. After treatment of the above mentioned minor his/her custody shall be returned to the Cypress Independent staff if I am not available. The undersigned parent and natural guardian does herby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the Waiver of Liability and Hold Harmless Agreement set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian. Parent/Guardian Signature: ________________________________________________ Date: ______/______/___________