As the parent/legal guardian of the student registering for a class, a minor, I do hereby authorize in my absence the registering CHILD/DANCER/STUDENT be admitted to any hospital or medical facility for diagnosis and treatment. In case of emergency, I understand every effort will be made to contact me. In the event that I cannot be reached, i give my permission to the medical personnel selected by West Sound Dance Academy and its representatives to secure proper treatment including hospitalization, anesthesia, surgery, or injects of medication for the registering child/dancer/student, my child. I request and authorize physicians, nurses, dentists and staff, to perform any diagnostic procedures, treatment procedures, and operative procedures to the registering child/dancer/student.
"Proper treatment" shall extend to and include the following non-exclusive list: x-ray, MRI, and other diagnostic imaging examinations, anesthetic, dental, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by the physicians or dentists.
It is understood that this release is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power to the West Sound Dance Academy and its representatives as my agent to give specific consent to any and all such diagnosis, treatment or hospital care which the physician, surgeon or dentist in the exercise of their best judgement may deem advisable.
I hereby accept any financial responsibility for any and all medical treatment necessary to be administered to the registering child/dancer/student in the event of an accident, injury, sickness, etc. I agree to hold harmless West Sound Dance Academy and all their respective officer, representatives, and employees from any and all claims which may be made for any cause arising as a result of or in connection with the participation of my child in the activities of West Sound Dance Academy.