Emergency Medical Release for Minors
This form needs to be signed by a parent or guardian and returned to Rock Springs Guest Ranch
In the event of an apparent or
real emergency, in which treatment or hospitalization
of ________________________________
(child's name) may be necessary, after effort to
contact me, the undersigned parent or guardian does hereby
authorize and appoint Rock Springs Guest Ranch to obtain any
medical treatment or hospitalization of the above named child
as they believe necessary and proper for the immediate care and
welfare of said child. I do further authorize any medical
doctor or hospital to render any and all treatment believed
necessary and proper for the immediate care and welfare of the
above named child. The undersigned shall hold Rock Springs
harmless from any and all liability claims as a result of any
such medical treatment or hospitalization.
Signature:_____________________________________
Date:_____________________
Please fill out, sign, and return
this for
to:
Rock Springs Guest Ranch
64201 Tyler Rd.
Bend, OR 97701
