Emergency Treatment Authorization

Applicable to: Spring Break Camp Summer Training Provincial Stream 2024 Spring Break Camp 2024 National Stream Development Program AquaGO Thursday Artistic Swim School Mon/Wed Artistic Swim Kids 1- Monday Olympic Dreams Summer Camp Aug 6-9 National Stream Program AquaGO Friday Summer Camp Aug 12-16 Artistic Swim School Tue/Thu Summer Training National Stream 2024 Artistic Swim Kids 1 - Thursday Summer Camp Aug 19-23 Artistic Swim Kids 1 - Friday Artistic Swim Kids 2 -Tuesday National Stream Custom K Provincial Stream - 12 & Under Program Summer Camp Aug 26-30 Provincial Stream - 13-15 Program Artistic Swimming for Teens Provincial Stream 16-20 Custom AquaGo Session 2 Artistic Swim Kids Tuesdays session 2 Artistic Swim Kids Thursdays session 2 National Stream custom SR

AS THE SWIMMER OR PARENT OR GUARDIAN, UNDER CIRCUMSTANCES BELOW, I HEREBY AUTHORIZE THE ADULTS IN CHARGE OF THE TEAM/CLASS, TO SECURE SUCH MEDICAL ADVICE AND SERVICES AS MAY BE DEEMED NECESSARY FOR THE HEALTH AND SAFETY OF MYSELF OR MY DAUGHTER/SON (OR WARD)

AND I AGREE TO ACCEPT FINANCIAL RESPONSIBILITY IN EXCESS OF THE BENEFITS ALLOWED BY PROVINCIAL HEALTH INSURANCE PLAN:

1. Where health and well being of the person is involved;

2. Where medical advice has been such that further services are required, services which require the consent of the parent or guardian;

Where all attempts to contact the parent or guardian have failed or where due to the nature of the emergency, there is insufficient time to contact such parent or guardian.

IT SHALL BE AT THE DISCRETION OF THE ADULTS IN CHARGE OF THE TEAM/CLASS AS TO WHAT STEPS MUST BE TAKEN FOR THE WELFARE AND SAFETY OF MYSELF OR MY DAUGHTER/SON.

As of 2024-07-12 7:44 PM