Authorization to Allow Event Supervisor to Consent to Minor's Medical Care*
I, the undersigned, am a parent or legal guardian authorized to give consent for medical and dental care of the participant identified above, a minor who is a participant in the above-mentioned event. I hereby authorize the event Supervisor or his/her adult designee, who are adults into whose care the minor has been entrusted, to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care to be rendered to the minor under the general or special supervision and upon the advice of a physician and surgeon licensed under the provisions of the Medical Practice Act, or to consent to an x-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care to be rendered to the minor by a dentist licensed under the provisions of the Dental Practice Act.
This authorization is given in advance of any specific diagnosis or treatment being required to provide authority to consent to and render care when a physician or dentist may deem it advisable, and pursuant to the provisions of section 6910 of the Family Code of California that states: "The parent or guardian of a minor may authorize in writing an adult into whose care a minor has been entrusted to consent to medical care or dental care, or both for the minor."
If I am a caregiver authorized to give consent for medical or dental care, but I am not the minor’s parent or legal guardian, I understand that I must provide to Santa Cruz Seaside Company a completed CAREGIVER’S AUTHORIZATION AFFIDAVIT before the minor can participate in the event.