Authorization for Emergency Medical Treatment for Volunteers

  • In case of Emergency Contact

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  • Consent Plan

    (to be invoked in the event that your Emergency Contact cannot be reached.) I give consent for emergency medical treatment/aid (including x-ray, surgery, hospitalization, medication, and any treatment procedure deemed “life saving” by the physician) in the event of illness or injury while on the property of the agency.*
  • If volunteer is under 18 years of age, both parent & volunteer signatures are required.
  • * If you choose non-consent for emergency medical treatment/aid in the event of illness or injury while on the property of the agency, please request a Non-Consent Form, which requires notarization.