I give my legal consent and authorize any representative of Maize USD 266, Sedgwick County, Kansas (the District) to authorize emergency medical treatment, including any necessary surgery or hospitalization, for my above-named child for any injury or illness of an emergency nature he/she incurred while participating in the activity noted above by any physician or dentist licensed in accordance with the provisions of the Kansas Healing Arts Act, K.S.A. 65-2801, et seq., and at any hospital. I agree to pay for and assume all responsibility for medical and hospital expenses and for any emergency service incurred on behalf of my child. To the full extent allowed by law, I hereby waive liability against the school district for injuries my child may incur as a participant in the activity and assume the risk of such injuries as a condition of my consent to permit my child to participate. I acknowledge and agree that Maize USD 266 is not responsible for any medical or hospital expenses and/or charges that are incurred in the medical treatment or hospitalization of my child. A photocopy of this document shall have the same force and effect as the original. If my child requires emergency medical treatment, I understand that school personnel will make a reasonable attempt to contact me to seek my permission to authorize treatment. To facilitate contacting me, I agree to provide current work, home, and cell phone numbers at the time of registration. This form must be completed as part of registration before the student named above is to participate in the field trip or activity.
