Release & Medical Consent:
I agree to the above-named person’s participation in Misericordia University’s non-credit programs, and waive, discharge, and forever hold harmless Misericordia University, its officers, directors, employees and all other liabilities, claims, cause, damages or demands resulting from participation in usage of equipment. In event of an emergency, I authorize that medical attention be administered to the participant named above.
By my electronic signature below I, the parent/guardian of the above-named minor child (the “Child”):
a. consent and agree to the Child’s participation in the above-named event (the "Event"), which I understand will take place on the campus of Misericordia University (the “University”).
b. authorize the Event staff to dispense the prescription drugs and/or over-the-counter medications listed immediately below in accordance with the instructions provided on the label or as otherwise set forth immediately below:
c. acknowledge that I understand that in the event a medical or other emergency involving the Child arises or occurs during the Event, or while the Child is being transported to or from the Event by University provided transportation, the Event Director or the Event Director’s designee will, as soon as circumstances reasonably permit, attempt to contact me at the telephone number I provided above to advise me of the circumstances.
d. in the event I am unreachable at the telephone number provided above, or circumstances require immediate action to protect the health and/or physical well-being of the Child, I authorize the Event Director, the Event Director’s designee, and any physician or other health care provider selected by the Event Director or Event Director’s designee, to take such action he or she determines is necessary to protect the health and physical well-being of the Child during the course of the Child’s travel to and from the Event through the use of University provided transportation (if applicable), and during Child’s attendance at and participation in the Event (including, but not limited to, if the Child has or experiences an illness, medical condition or episode, and/or an accident during any such time). This authorization includes, but is not limited to, the authorization to (i) have the Child evaluated by a health care provider for the purpose of determining if medical treatment is necessary, (ii) have proper medical treatment, including the transfusion of blood and/or the injection or other administration of anesthesia, medication/legal drugs, provided to the Child, (iii) have the Child hospitalized, and (iv) have any necessary surgical procedure performed on the Child in the event I am unavailable to consent to such a procedure. I acknowledge that I am responsible for all reasonable costs, charges and fees which arise in connection with actions taken to protect the health and/or physical well-being of the Child in accordance with the terms of this paragraph.
e. am voluntarily providing the following additional information so that the Event Director, or the Event Director’s designee, may utilize it as necessary in making decisions regarding the health and/or physical well-being of the Child:
f. in consideration of the Child’s participation in the Event, and on behalf of the Child myself, any other parent or guardian of the Child, as well as any heir(s) of the Child, of mine, and/or of any other parent or guardian of the Child, I hereby waive, discharge, and forever hold the University and its respective officers, trustees, employees, contractors, vendors, agents, legal and other representatives, insurers and assigns, past and present (and whether in such capacity, individually, or in any other capacity), from, any and all liabilities, claims, injuries, illness, actions, causes of action, damages, demands, obligations, rights, costs, expenses, and/or attorneys’ fees which arise from, or are in any way related to, the: (a) Child’s attendance at and/or participation in Event (including, but not limited to the Child’s use of any equipment, tools, products and/or other materials in the course of participating in the Event); and/or (b) the transportation of the Child to and/or from the Event.