1738 Consent For Medical Treatment In Canada YL1738
User Manual: 1738
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CONSENT FORM FOR MEDICAL TREATMENT IN CANADA GOVERNING LAW I hereby agree that the relationship and the resolution of any and all disputes arising there from between myself and the Malibu Club physicians relating to medical treatment received during the week of _________________________ shall be governed by and construed in accordance with the laws of the Province of British Columbia. To obtain a copy of Young Life’s Notice of Privacy Practices, log on to www.younglife.org or call (719) 381-1953. HTU UTH JURISDICTION I hereby acknowledge that any complaint, demand, claim or cause of action, whether based on alleged breach of contract or alleged negligence arising out of any medical treatment received from the Malibu Club physicians, would be governed by the jurisdiction of the Province of British Columbia. By signing this statement, I hereby understand and agree that if I commence any such legal proceedings, they will be limited to the exclusive jurisdiction in the Courts of the Province of British Columbia. __________________________________ Name __________________________________ Signature Date All minors visiting Malibu Club must have this form signed by their parent/guardian prior to leaving for camp. YOUNG LIFE SHALL NOT BE HELD LIABLE AT ANY TIME FOR LOST OR STOLEN LUGGAGE OR PERSONAL ITEMS. ___________________________________ Parent’s Signature Date Required for minors U U ___________________________________ Parent’s Printed Name ____________________________________ Witness Signature (Notary not required) Date Required for minors U U ____________________________________ Witness’ Printed Name YL-1738 11/09 Printed in U.S.A.
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