May We Text You?
Permission is given to the adult in whose care the minor/minors has been entrusted to consent to any x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care to be rendered to the minor under the general or special supervision and or the advice of a physician or dentist licensed under the provision of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the of said physician or at said hospital. You shall be liable, and agree to pay all cost and expenses incurred in connection with such medical and dental services rendered to participant pursuant to this authorization. Further should it be necessary to participant to return home due to medical reason, disciplinary action or otherwise, you herby assume all transportation cost. You give permission for the participant to rind in any adults vehicle designated by the leader in whose care the minor participant has been entrusted while attending and participating in activities sponsored by Ponca City Assembly , travel to and from such activities. You understand that if necessary participant will be taken to a nearby hospital and will be attended to by the physician on call . You further understand that you are responsible for medical expenses, and or other expenses, incurred by participant because of illness, (2) for any medical expenses incurred above the maximum amount of insurance coverage carried by Ponca City Assembly (3) and you give permission to transport participant in any vehicle authorized by the PCA leader.
