MEDICAL CONSENT FORM

I, ____________________ hereby consent to any first or second aid, or any hospital care or medical or surgical diagnosis or treatment to be rendered to me, as found advisable, that may arise from my participation in activities with the Texas Mountaineers.

I understand and agree that I am solely responsible for all appropriate charges for such services.

Are there any existing medical conditions or other special considerations of which we should be
aware? ___________________________________________________________________________

Are you allergic to any medication? ____________________________________________________

Signature ______________________________________ Date _____________________________

MEDICAL CONSENT FORM

I, ____________________ hereby consent to any first or second aid, or any hospital care or medical or surgical diagnosis or treatment to be rendered to me, as found advisable, that may arise from my participation in activities with the Texas Mountaineers.

I understand and agree that I am solely responsible for all appropriate charges for such services.

Are there any existing medical conditions or other special considerations of which we should be
aware? ___________________________________________________________________________