Fillable UNDERAGE FORMS Medical Care and Treatment of Minor (Cascadia Community College)

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UNDERAGE FORMS Medical Care and Treatment of Minor (Cascadia Community College)

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UNDERAGE FORMS
Student Name (Last, First) ______________________________________________
Student ID Number _________________________________
Medical Care and Treatment of Minor Children Consent
Hospitals and doctors may be reluctant to treat or care for children under the age of 18 without consent
from parents or legal guardians. This can cause problems if the child has a medical emergency and the
parents/guardians are not readily available to consent to treatment.
_____________________________________________________ (Print name of parent/legal guardian)
I authorize and consent to medical, surgical and hospital care, treatment, and procedures to be
performed for by a licensed physician or hospital when, at the sole discretion of the attending physician,
immediate care, treatment, and procedures are necessary or advisable in the interest of my child’s
health and well-being, and it is not advisable to take the time to contact me in advance. Under the
circumstances described above, I elect not to be informed in advance of the nature and character of the
proposed treatment, its anticipated results, possible alternatives, and the risks, complications, and
anticipated benefits involved in the proposed treatment and the alternative forms of treatment,
including non-treatment.
_____________________________________________ ______________________________
Signature of Parent/Guardian Date
Off-Campus Activities and Trips Waiver of Liability
I understand and acknowledge that there is risk of injury to my child by his/her participation in off-
campus activities and trips. I also understand that it is voluntary for my child to participate, and that the
college does not require his/her participation. I hereby release Cascadia College and the State of
Washington, its employees, officers, agents, and trustees, and waive any and all right and claims for
damages from any and all injuries that my child may suffer as a result of his/her participation in trips
and/or activities. I also agree to hold harmless and indemnify Cascadia College, its employees, officers,
agents, and trustees for any action, claim, or proceeding initiated as a result of any injury suffered by my
child or any third party through his/her participation in trips and/or activities.
_____________________________________________ ____________________________________
Print Name of Parent/Guardian Signature of Parent/Guardian
_____________________________________________ ____________________________________
Parent/Guardian email address Emergency phone of Parent/Guardian
Student Name (Last, First) ______________________________________________
Student ID Number _________________________________
As an underage student, Cascadia College has permission to contact my parents and/or agent at any
time with concerns they may have in regards to academic or personal matters.
_____________________________________________ ______________________________
Signature of Student Date
Name of both Parents: _________________________________________________________________
Parents’ email addresses: _______________________________________________________________
Parent’s Cellphone numbers: ____________________________________________________________
Parents’ Work phone numbers: __________________________________________________________
Name of Agent: _______________________________________________________________________
Agent’s Phone number: _________________________________________________________________
Cascadia Underage Student Housing Policy
It is Cascadia College’s policy that all students under the age of 18 live with a homestay family in order
to ensure their safety while attending classes in the United States. Cascadia College strongly
recommends that parents keep their child in a homestay where they can be monitored and cared for
until the age of 18, when they are legally considered to be adults in the U.S.
If parents decide to allow their underage child to live anywhere other than with a homestay family, they
must sign the Housing Policy Waiver below.
______________________________________ as a parent of __________________________________
Name of Parent Name of Student
I hereby grant permission for my child to arrange for housing in an apartment/room for rent, etc.
contrary to Cascadia College’s policy that all underage students reside in a homestay. I understand the
consequences of allowing my underage child to live unsupervised and release Cascadia College from any
and all liabilities in regards to any harm that may come to my child as a result of my choosing to
disregard their underage homestay policy.
_____________________________________________ ______________________________
Signature of Parent Date
EMERGENCY CONTACT FORM
Student Name (Last, First) ______________________________________________
Student ID Number _________________________________
TO BE COMPLETED BY A U.S. EMERGENCY CONTACT_________________________________________
I confirm that I am at least 18 years old and am appointed to be responsible for the student named
above while he/she is attending Cascadia College. I confirm that the following information is accurate,
that I reside in the United States, and that I will notify the school of any changes to my contact
information.
U.S. Emergency Contact Name: __________________________________________________________
Relationship to the Student: _____________________________________________________________
Emergency Contact Address: _____________________________________________________________
_____________________________________________________________________________________
Emergency Contact Email Address: ________________________________________________________
Telephone Number: Cell: _______________________ Work:_________________________________
Emergency Contact Signature: ____________________________________ Date:__________________
TO BE COMPLETED BY THE STUDENT_______________________________________________________
Please read the following statement and sign on the line below
I understand that while I am under the age of 18, I must reside with a host family, immediate family
member, or get the approval of my parent/legal guardian to live independently. I also understand that it
is my responsibility to notify the International Programs if I change my address.
_____________________________________________ ______________________________
Signature of Student Date
To be completed by the International Programs Office
Advisor’s Initials Advisor’s Printed Name Date
□ Scan and E-file □ Email the student □ Update Database □ Update SEVIS
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UNDERAGE FORMS Medical Care and Treatment of Minor (Cascadia Community College)

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Completed 8 October 2020

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