In the event of an emergency which affects the health of the camper, I the undersigned, do hereby authorize officials of the JEWISH COMMUNITY CENTER to contact the persons named on this form and if neither parent nor guardian can be contacted, I authorize the named physician to render such treatment as may be deemed necessary these people can be rached, I hereby give the personnel of the Jewish Community Center of Dallas permission to make arrangements for emergency medical attention, to transport the camper to an accredited facility for diagnosis and treatment and to authorize the administration of medication as necessary.
I request and authorize physicians, dentists and staff of the accredited medical fracility to perform any diagonstic procedures, treatment procedures, x-ray treatments and administration of anesthetics as may be necessary in the diagnosis and treatment of above minor camper. I understand that I have not been given a guarantee as to the this authorization. Further, I will not hold the Jewish Community Center or their Officers, Directors, administrators, Teachers, Personnel or Employees financially responsible for the emergency care and/or transportation for said child. The authority granted herein expires one year from acknowledged date.