Required fields are shaded in red.
IN THE EVENT OF AN EMERGENCY
I hereby give my consent for medical treatment to be given as may be deemed necessary by a physician in the event
of injury or accident. I understand Chaminade University will not be held liable or responsible for any financial
obligation incurred related to medical treatment. I understand an immediate attempt will be made to contact
persons at my home residence in such an event.
Signature must be by a parent or legal guardian if student is a minor, or student if 18 years of age or older.