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Deer Hill Expedition’s Permission to Treat Signature 

Permission to Treat

  • I, participant and parent of a minor participant, agree as follows: I authorize DHE staff, representatives and/or other medical personnel to obtain or provide medical care for the participant, to transport the participant to a medical facility and to provide treatment (including, but not limited to hospitalization, medications, anesthesia, surgery) they consider necessary for the participant’s health. I agree to pay all costs associated with this care and transportation, including but not limited to medical evacuation, travel, compensation and expenses for staff accompanying participant, medicine and treatment. I agree to the release (to or by DHE representatives) of any records necessary for treatment, referral or otherwise. I certify that the information provided above, and in any supplemental DHE medical forms (those completed forms are incorporated by this reference) is true, complete and accurate. Other than any limitation/s described in this form or supplemental forms, I agree participant can participate in all DHE activities. I understand the nature of DHE activities, and acknowledge that I can contact DHE should I have any questions about these activities and the associated physical, mental or emotional demands or other concerns. I will contact DHE if any medical history/condition changes before the start of (or during) the program and understand that all participants share in the responsibility for their own well being and the well-being of others on the expedition. I acknowledge that providing inaccurate medical information or falsifying medical information can create serious risks to participant or others, and/or result in participant’s dismissal from the program. I understand that participant’s final acceptance and participation in the program is contingent upon DHE’s receipt and review of all forms, including this form and all supplemental medical forms. I understand that although DHE will review this information and may allow participation, DHE cannot anticipate or eliminate risks or complications posed by a participant’s mental, physical (including fitness level), or emotional condition. I understand that emergency, medical, drug and/or health issues, response, assessment or treatment are included within the scope of – and expressly subject to the terms of – the DHE Acknowledgment and Assumption of Risks & Release and Indemnity Agreement. The participant and the parent of a minor participant (those under 18 years of age) must sign below.
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