Washington State University-Extension Spokane County 4-H
Emergency Medical Release – Youth (and Adult) Form
Spokane County 4-H Events
In an emergency requiring medical attention or a situation reasonably believed by Washington
State University (WSU) authorized agents including staff and volunteers to be an emergency; I
authorize WSU and its authorized agents to obtain emergency medical care for my child. I will
be responsible for any expenses incurred in so doing including but not limited to care by health
care professionals, hospital care, and ambulance or other services. In addition, the health care
provider has permission to obtain a copy of my child’s health record from providers who treat
my child and these providers may talk with the program’s staff about my child’s health status.
NOTE: Minors may consent to certain services in Washington.
I hold harmless and agree to indemnify Washington State University, its authorized agents
and employees and the staff of the above named club