Flemington Wrestling Club (High School)

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Insurance Information
MEDICAL RELEASE

In case of medical emergency, I hereby authorize the listed physicians and/or their designated associates or assistants, or their covering physicians, or in the event those persons cannot be contacts, the emergency physician on duty at the hospital to provide emergency treatment to our child for the following:
A. Any laceration, fracture, or other traumatic injury; or
B. Any symptom, disease or injury, which in the judgement of the attending physician, if untreated, reasonably may be expected to increase the risk of or threaten disfigurement of impairment of his facilities.

Major surgery or general anesthesia may be administered if:
A. The life or health of my child is in danger; or if delaying treatment to obtain consent would create a threat or serious injury to the health of my child; and
B. The attending physician and one other physician consult and agree that such treatment is necessary for the health of my child.

This consent is to be effective only after reasonable efforts have been made to contact me and obtain my specific consent to any emergency treatment. This consent is also to be used in conjunction with the hospital's procedure for documented administration authorization.

NEW FOR THE 2017-2018 SEASON: WE WILL BE REQUIRING ONE OF THE FOLLOWING:
1. A COPY OF YOUR CHILD'S HEALTH PHYSICAL FROM THE PAST YEAR.
2. A NOTE FROM YOUR CHILD'S PHYSICIAN STATING THAT YOUR CHILD IS FIT TO WRESTLE IN OUR PROGRAM
3. THE ELKS MEDICAL CONSENT FORM SIGNED BY YOUR PHYSICIAN.
WAIVER AND RELEASE
The undersigned, individually and/or acting through his/her parent or legal guardian on his/her behalf in consideration of acceptance into the Flemington Wrestling program and participation therein, agrees to waive any right, legal or equitable, to claim damages for any loss to person or property occasioned by participation in such programs, or in any events in which participates or is involved,and further agrees not to hold the Flemington Wrestling Association, Inc., its officers, directors, coaches, agents, servants, employees or sponsors, liable in any way, measure or form for any such claims or the payments of such damages, and does hereby release the said persons from liability on account of any injury to person or property. The undersigned also agrees to assume all financial responsibility for any and all medical treatment for his/her child.

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