Parent or legal guardian should fill out this section.
I certify that the participant acknowledged in my presence that he/she has read and fully understands the meaning and consequences of the foregoing AGREEMENT and signed it in my presence.
Medical Treatment Authorization for Participation of a Minor
I represent and warrant to Rebuilding Together OKC that I am the parent or legal guardian of the minor named above. The above named minor has my permission to participate in the Rebuilding Together project (the “Project”). On behalf of such minor and myself, I have signed a Volunteer’s Agreement and Release from Liability (the “Release”) and hereby agree to all of the terms and conditions of the Release.
In case of medical or dental emergency, I request that Rebuilding Together attempt to contact me at the telephone number set forth below. However, I hereby give permission to the physician or dentist selected by Rebuilding Together to hospitalize, treat, secure proper treatment for, and order injection, anesthesia or surgery for the minor named above. A copy of the permission form may be accepted by and treated by the physician or dentist as equivalent to the original permission form.