General KCC Policies and ProceduresFirst Aid and Emergency Medical TreatmentVersion dated: March 19, 2004 I recognize that there may be occasions where I may be in need of first aid or emergency medical treatment as a result of an accident or illness. I hereby give permission for agents of KCC to seek and secure any medical treatment, including hospitalization, which may be deemed necessary and reasonable under the circumstances. I agree to pay all fees and costs arising from such action to obtain medical treatment. This permission for emergency medical treatment also includes minors under my control. Dated: ____________________ Sign Name: __________________________________ Print name: __________________________________ Address:_________________________________________________ ________________________________________________________________ Emergency Contacts Medical Doctor________________________ Phone _____________________ Name____________________________________ Relation_______________________ Home Phone__________________ Other phone___________________ Name____________________________________ Relation_______________________ Home Phone__________________ Other phone___________________ Medical History and Special Medical Needs ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________
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