Medical form

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Note: Students with asthma are encouraged to keep inhalers with them at all times
Note: Students with asthma are encouraged to keep inhalers with them at all times

Notice

Dordt University does not employ or provide nursing or medical personnel on campus during academic or athletic camps. Medical emergencies, if any, are addressed through local emergency medical response personnel.

Emergency Authorization/Consent to Medical Treatment

By signature below, I authorize Dordt University and its representatives, if present, to provide to my child, through medical personnel of their choice, customary medical assistance, transportation, and emergency medical services should my child require such assistance, transportation, or services as a result of injury, illness or damage while participating in or related to my child's participation in camp. This consent does not impose a duty upon Dordt University or its representatives to provide such assistance, transportation, or services.

Financial Responsibility

By signature below, I accept financial responsibility for all medical treatment provided to my child at Dordt University's request. I also understand and acknowledge that Dordt University is not responsible for administering any medications to my child.

Applicable Law

Because Dordt University is located in the State of Iowa, and in order to provide certainty in the law to be applied to the construction of this instrument, this Consent shall be governed, construed and enforced in accordance with the law of the State of Iowa.

By signing this form, you agree to the information and statements listed above.