I (we), the undersigned parent, parents or legal guardian of the student above named, a minor, do hereby request that he/she be permitted to attend any field trips, excursions or classes given by Home Educators Resource Center; should the need arise, I do hereby authorize and consent to any X-ray examination, anesthetic, and medical or surgical diagnosis rendered under the general or special supervision of any member of the medical and emergency room staff licensed under the provisions of the Medicine Practice Act, dentist licensed under the provisions of the Dental Practice Act and the staff of any acute general hospital holding a current license to operate a hospital from the state of California Department of Public Health. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power to render care that the aforementioned physician in the exercise of his best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatments will not be withheld if the undersigned cannot be reached. I will not hold liable Home Educators’ Resource Center, Calvary Chapel Westbrook, their officers, or employees for medical aid rendered and will reimburse them for the medical or other expenses incurred in the care of my student.
This authorization is given pursuant to Section 25.8 of the Civil Code of California and remains effective only for the student listed at the top of this document.
Calvary Chapel Westbrook and Home Educators’ Resource Center do not pay physician fees or medical expenses of students who are injured on the campus or during Calvary Chapel Westbrook or Home Educators’ Resource Center activities.
