I/we the undersigned, parent(s)/legal guardian of the minor named above do hereby authorize Abundant Life Ranch, or Doug or Betsy Cockrell, as agents for me/us to obtain medical treatment for the above mentioned minor as a result of accident, injury, or illness while participating in the horse camp events. This consent includes any x-ray, exam, anesthetic, medical, or surgical diagnosis or treatment and hospital care when deemed advisable by, and rendered under the general or special supervision of, any physician or at said hospital. This authorization is given pursuant to the provisions of Section 26, B of the Civil Code of California.
I/ we as parent(s)/legal guardian(s) will assume responsibility for all costs for necessary treatment as needed and allowed by this authorization form. In order to simplify this process our insurance carrier is:
I/We further authorize any hospital which has provided treatment to the above minor to surrender physical custody of such minor to the above named agent upon completion of treatment. This authorization is give pursuant to Section 1233 of the Health and Safety Code of California and shall remain in effect through the child’s time at camp.