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2023 MeckMIN Youth Summit Medical Consent Form

Participant's Information:


Parent/Guardian Information:

To whom it may concern,

The undersigned does herby give permission for our (my) child lsited above to attend and participate in all activities and events sponsored by or participated in by MeckMIN and its ADULT LEADERS and VOLUNTEERS.

The undersigned does also hereby give permission to our (my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by or participated in by MeckMIN.

Emergency Care: We (I) hereby authorize an adult, in whose care the minor 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 above minor under general or special supervision and on the advice of any licensed physician or dentist on the medical staff of a licensed hospital or medical center whether such diagnosis or treatment is rendered at the office of said physician, said hospital, or said medical center. 

The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this otherwise , the undersigned shall assue all transportation costs.