I, the undersigned parent, parents or legal guardian of the above named minor, hereby authorize, in the event of injury, accident or illness, IC.B.A., its coaches, team representatives, directors, officers, agents and assigns to seek and obtain such medical care and treatment as may be necessary under the circumstances for my child.
I hereby authorize and consent to my child undergoing such medical treatment and hospital care as may be deemed advisable and provided under the general or special supervision of any medical and emergency room personnel licensed under the provisions of the Canada Health Act, any licensed dentist and the staff of any general hospital holding a valid license to operate a hospital.
This authorization is effective whether such diagnosis or treatment is rendered in the office of said physician or dentist, in a hospital or elsewhere. It is understood that this authorization is given prior to any specific diagnosis, treatment or hospital care being required, but is given to confer authority and power on the part of my aforementioned agents to give specific consent to any such diagnosis as, in the exercise of his or her best judgment, he or she may deem desirable.
I understand that efforts must be made to contact the undersigned prior to giving treatment to the patient, but that none of the above treatment will be withheld if the undersigned cannot be reached. I further agree that this authorization for treatment will be valid in any province where such treatment is rendered. I also agree that if French is not my first language, I have sought someone to translate this form for me and I agree that by my signature I have read and understood the document and all its words and provisions.