2023 MGO BR Medical Treatment Authorization & Consent Completion of this form is Required if Accompanying Adult is not the Parent or Guardian of minor Participant (ages 16-17).HiddenDate MM slash DD slash YYYY I am the parent or guardian of:(Required) Add RemoveClick on (+) sign after field to add additional minor.Accompanying Adult for minor(Required) First Last Email(Required) Consent(Required) I authorize this below.As the parent or guardian of minor Participant, I authorize the Accompanying Adult to arrange or provide medical treatment for the minor(s), including but not limited to helicopter evacuation, ambulance service, medications, first aid, hospitalization, and surgery; ■ execute any forms, consents, and releases as may be useful under the circumstances; and ■ delegate the authority granted herein to any other person(s). I understand that efforts will be made to contact me if medical treatment should be needed. I will ensure that the minor will bring any necessary medications on the trip.Parent or Guardian Name(Required) First Last Parent or Guardian Signature(Required) Reset signature Signature locked. Reset to sign again EVENT: 2023 MGO Buffalo River Expedition | June 11-14, 2023Buffalo National River, Arkansas To reveal submit button, what is 7+4?(Required) 11 3 14 Date MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged. Go ahead and share:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on WhatsApp (Opens in new window)Click to print (Opens in new window)
