Emergency Medical Care Agreement
In the case of injury to, or illness of, a child while at Temple Beth Hillel, every effort will be made to contact the parent(s) or guardian(s). If a representative of Temple Beth Hillel is unable to reach such person, the following instruction will remain in force unless revoked by the parent or guardian: I hereby authorize Temple Beth Hillel or any authorized representative to call my child's physician or dentist (or another physician or dentist available) for necessary care for my child in case of an emergency. I agree to pay all expenses incurred. The authorizations shall be in effect September 8 - September 20, 2017. In addition, I do hereby authorize a representative(s) of Temple Beth Hillel as agent(s) for the undersigned to consent to an x-ray examination, anesthetic, medical or surgical diagnoses or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any licensed physician or surgeon, whether at the said physician's office or licensed hospital. It is understood that this authorization is given in advance of any specific examination, diagnosis, treatment or hospital care being required, and is given to provide authority and power on any and all such examination, diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable. I acknowledge that Temple Beth Hillel's liability insurance coverage provides secondary coverage only. In the event of a claim, the Temple Beth Hillel policy will not cover any expenses to the extent that they are payable under the claimant's primary insurance coverage.