Emergency Treatment Authorization

Applicable to: Summer Training PS 13-15, 11/12, 10U Spring Break Camp Session 2 AquaGo Summer Camp Aug 19-23 National Stream Regular Training Spring Break Camp 2024 Artistic Swim School AquaGO Artistic Swim Kids - Monday Olympic Dreams Artistic Swim Kids -Tuesday Summer Camp Aug 26-30 Summer Training NS & PS 16-20 Artistic Swim Kids - Friday National Stream Custom Exchange training National Stream Senior Mara National Stream Custom K Artistic Swim Kids Mon session 2 Provincial Stream - Development Program National Stream Senior Liz Artistic Swim Kids Tue session 2 Provincial Stream - Experienced Program Artistic Swimming for Teens Artistic Swim Kids Fri session 2 Provincial Stream 16-20 Custom National Stream Senior Alyssa National Stream Avery BD 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 2024-04-26 4:24 PM