Emergency Authorization
I/We the undersigned dancer/parent(s)/legal guardian(s) of the registered dancer, do hereby authorize the dance directors, Parish Priest or parents of the group acting in the capacity of activity supervisor/vehicle driver, as agents for the undersigned to consent to medical, surgical or dental examination, treatment, etc. In case of emergency, I/We hereby authorize treatment and/or care of registered dancer at any hospital. If there is an emergency and I/We cannot be reached, please contact the emergency contact person stated below whom is hereby authorized to act in the dancer’s behalf.
If you wish to have a family doctor contacted in case of emergency, please list: