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39th Beautillion Ball
Emergency Medical Consent Form

The Fun-Set Social and Charity Club will attempt to notify parent/guardian or designated emergency contact if your child becomes ill or injured.
In the event of a medical emergency, your child will be taken to the nearest emergency hospital for diagnosis and/or treatment
regardless of parental notification.

Emergency Contact if Parent/Guardian Cannot be Reached

Medical Authorization

I hereby release the Fun-Set Social and Charity Club, its agents or assigns, from any and all liability relating to any physical injury which may occur as a result of my child's direct or indirect participation in activities under the supervision and direction of the Fun-Set Social and Charity Club, and all participating medical personnel from any and all liability associated with the care and treatment of my child. 
I understand that the Fun-Set Social and Charity Club, and its members assume no liability or any nature whatsoever in relation to any transportation of (Prospective Beau) for the purpose of securing medical and/or dental treatment.

I further understand that all medical and dental treatment, examinations, x-rays, cost of ambulance or hospitalization provided in relation to this authorization shall be borne by the undersigned. 

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