Parent Certification, Acknowledgement, Release, and Waiver
I, the undersigned parent or legal guardian, hereby certifies that the information on this Visiting Student Information Form is complete and accurate.
I do hereby authorize the International School of Denver (ISDenver) as an agent for the undersigned identified above to consent to any emergency transfer, X-Ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care of the Visiting Student identified above which is deemed advisable by and to be rendered under the general or specialized supervision of any EMS, physician, or surgeon licensed under the provisions of the Medical Practices Act, or the medical staff of Children's Hospital Colorado or the best available hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospitalization care being required, but is given to provide authority or power on the part of my above-said agent to give specific consent to any and all such diagnosis, treatment, or hospital care which the aforementioned physician in the exercise of his or her best judgment may deem advisable in case of emergency only. This authorization shall remain effective until the Visiting Student is signed out in writing from the International School of Denver.
Parent agrees to release and hold harmless ISDenver, its officers, directors, employees, and agents from all claims, damages, or other liabilities for injuries to Student, other than for injuries from the gross negligence of ISDenver, its agents, or employees. Parent agrees to indemnify ISDenver and its officers, directors, employees, and agents for any damage caused by Visiting Student or Parent.
Parent also understands and acknowledges that the International School of Denver’s insurance policy does not cover Visiting Student and hereby waives any claim to ISDenver’s insurance. Parent hereby affirms that Visiting Student has insurance that will cover him/her while visiting ISDenver.