Medical Release Of Liability Form (on...

Authorization For Emergency Medical Care (Adults)

Born,

Do hereby authorize any necessary or emergency examinations, anesthetic, dental, medical or surgical diagnosis, or treatment by any duly licensed physician, dentist, or hospital service that may be deemed necessary should I experience any illness or accident while traveling with Embrace and Reach International of Morgan Hill, California to...

This release is effective starting from...

And goes until...

By signing this, I release and discharge Embrace and Reach International of any cost and/or responsibility incurred by my medical treatment and assume full responsibility for all cost or damages arising from any emergency or necessary medical/dental or surgical treatment given to me or performed on my behalf while traveling with Embrace and Reach International.

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