do hereby request and give permission for the provision of necessary medical treatment for the above-named child. I/we understand that supervisory personnel will immediately seek to reach the above-named child’s contact(s) in case of a medical emergency. If any injury/incident does occur during this event that requires transportation to a hospital or doctor, I/we give permission for a representative of the parish/school/etc. to secure necessary medical attention. I/we further authorize any duly qualified physician, dentist, or hospital to render such aid or treatment that may be necessary and understand that I/we assumeresponsibility for the cost of any such treatment. I/we authorize the release of pertinent medical information to supervisory personnel.* Please understand that, depending upon the seriousness of the situation, your child may be transported to the nearest hospital.