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Consent to Emergency Medical/Dental Care and Authorization to Release Informaton
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Although Freedom Mountain Academy will contact parents/guardians immediately in the event of emergency medical treatment, parents of students under 18 years of age must sign and have notarized the following statement to allow possible emergency or dental care if necessary while the student is enrolled in Freedom Mountain Academy.
I hereby authorize Freedom Mountain Academy to arrange, and an emergency service agency and any physician or dentist associated with them to give, whatever care in their professional opinion is necessary for my minor child while a student at Freedom Mountain Academy. The School and any emergency service agency and their associated physicians, surgeons, and/or dentists, have my authorization to consult together as necessary. I hereby give my consent to any X-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital service, and for the performance of an operation with whatever anesthesia is necessary at the discretion of the surgeon or anesthesiologist, whether such diagnosis or treatment is rendered at the physician’s office or at a licensed hospital. It is understood that this consent is given in advance of any specific diagnosis or treatment which may be required and is given to authorize Freedom Mountain Academy, its Director or designee, and physicians to exercise their best judgement as to the requirements of such diagnosis or treatment. It is further understood that this consent authorizes Freedom Mountain Academy to communicate with health-care providers regarding diagnosis and treatment, and to have access to the same information regarding diagnosis and treatment accessible to us if we were present. I hereby accept all responsibility for expenses in connection with the above and understand that neither a hospital nor Freedom Mountain Academy is to assume financial responsibility for my minor child. Charges for emergency services will be honored by me as if I had arranged for those services in person. This authorization remains in effect until revoked in writing by me.
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