I, the undersigned, parent or legal guardian of the participant, a minor, hereby authorize the Family Wellness Center staff, coaches and other participating parents acting in good faith and in the capacity of program volunteers, to serve as agents in my absence to consent in medical, surgical, and/or dental examination or treatment in case of emergency, and/or hospital care. If there is an emergency, and I cannot be reached, please contact the following emergency contact. PLEASE WRITE EMERGENCY CONTACT FULL NAME AND PHONE NUMBER(S) *