Parental/Guardian Consent Form and Liability Waiver

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I/We, the undersigned, are the parent(s)/guardian(s)of the above named child/children andI/we agree, in taking advantage of the child care services provided by Morehouse School ofMedicine (“MSM”), to release and hold harmless MSM, its directors, offices, employees andconsultants from any and all claims, demands, suits, cost, and charges in connection with orarising out of provision of the child care services, including, but not limited to, bodily harm orinjury to my/our children, except only for loss, harm or injury occasioned by gross negligence orintentional misconduct by MSM. We/I hereby grant permission for MSM and its personnel fullauthority to take whatever actions they deem necessary regarding my/our child’s health andsafety in the event I/we cannot be reached or in the situation where time is of the essence; andfully release MSM and its personnel from any liability in connection with those decisions. I/wegrant permission for emergency treatment by a rescue squad, private physician and/or hospitalor emergency health care facility staff, if needed. I/we acknowledge that MSM will take anysuch action in the best interest of my/our child and MSM will report such action to me/us assoon as possible.
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