MEDICAL RELEASE POLICY: CONSENT TO TREAT A MINOR
I/We, being the parent(s) or legal guardian(s) of the above named child, do herby appoint the staff of Jane Addams Peace Camp to act in my/our behalf in authorizing any X-ray, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care for the above named minor during my/our absence. This document may be relied on by any licensed physician, surgeon, dentist or appropriate hospital representative in accordance with section 25.8 of the Civil Code of California. I/We authorize any hospital which has treated the above minor to surrender physical custody of the minor to my/our/above named agent. This authorization conforms to Section 1283 of the Health and Safety Code of California.