MEDICAL AUTHORIZATION FOR TREATMENT OF MINOR
On rare occasions, an emergency requiring hospitalization and/or surgery develops. Since minors may not, as a rule, be administered an anesthetic or be operated on without the written consent of the parent or guardian, we request that parents or guardians sign the following statement. Every effort will be made to contact the parents or guardian before any major treatment. This document is intended to prevent a dangerous delay in case an emergency does occur and we are unable to reach parents.
In the event of injury or illness to my son/daughter/ward_________________________ born _______________________, I hereby authorize Elisabeth (Babette) Grunwald, GAPP Coordinator, or Heidi Holderman, GAPP Chaperone, or
___________________________________________________(parents of the German host family with whom my son/daughter/ward is staying) to secure whatever treatment is deemed necessary, including the administration of an anesthetic, surgery, or dental treatment.
_____________________________
Date
____________________________
Parent Signature
____________________________
Parent Name (printed)
On rare occasions, an emergency requiring hospitalization and/or surgery develops. Since minors may not, as a rule, be administered an anesthetic or be operated on without the written consent of the parent or guardian, we request that parents or guardians sign the following statement. Every effort will be made to contact the parents or guardian before any major treatment. This document is intended to prevent a dangerous delay in case an emergency does occur and we are unable to reach parents.
In the event of injury or illness to my son/daughter/ward_________________________ born _______________________, I hereby authorize Elisabeth (Babette) Grunwald, GAPP Coordinator, or Heidi Holderman, GAPP Chaperone, or
___________________________________________________(parents of the German host family with whom my son/daughter/ward is staying) to secure whatever treatment is deemed necessary, including the administration of an anesthetic, surgery, or dental treatment.
_____________________________
Date
____________________________
Parent Signature
____________________________
Parent Name (printed)