[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288793-105":53,"doc-detail-288793-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","medical-treatment-authorization-form-for-a-minor-youth-programactivity","Medical Treatment Authorization Form - for a Minor - Youth Program/Activity","","Attachment D provides a Medical Treatment Authorization Form for minors participating in a Youth Program/Activity. It collects participant and parent/guardian details, emergency contact information, known allergies, and current medications. The form grants authorized staff/adult volunteers consent to receive medically necessary care, including diagnosis, treatment, hospitalization, and related procedures under California licensing statutes. Consent remains effective through the program unless revoked in writing, and it includes both authorization and non-consent options with signature and date fields.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/medical-treatment-authorization-form-for-a-minor-youth-programactivity/288793/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/medical-treatment-authorization-form-for-a-minor-youth-programactivity/288793.png","ImageObject",442,249,{"name":88,"@type":89},"Melati","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-12","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What medical care does the authorization cover for a minor?","Question",{"text":109,"@type":110},"It covers medical or surgical diagnosis and treatment, including hospital care deemed advisable and supervised by licensed physicians or dentists, plus related procedures such as x-ray examinations and anesthesia as needed.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How long is the consent effective?",{"text":114,"@type":110},"The authorization remains effective until the child completes activities in the program, unless revoked sooner in writing.",{"name":116,"@type":107,"acceptedAnswer":117},"What happens if the parent/guardian chooses non-consent?",{"text":118,"@type":110},"Non-consent prohibits the minor from receiving any non-life-threatening medical attention in the event of illness or accident.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},288793,1791022722,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":4},962085570644,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","ATTACHMENT D: MEDICAL TREATMENT AUTHORIZATION FORM  \nYouth Program/Activity:   Name of Participant:  Parent/Guardian Name:   Phone:  Emergency Contact:   Phone:   Relationship:  Existing Medical Coverage:   Plan \\#  Known Allergies:   Current Medications:   I herby voluntarily permit my child to participate in the [Program/Activity] at [Campus name] .  \nWhile my child is attending or traveling as part of this Activity/Program, I HEREBY AUTHORIZE THE STAFF/ADULT VOLUNTEER, or in his/her absence or disability, any adult accompanying or assisting him/her, TO CONSENT TO THE FOLLOWING MEDICAL TREATMENT FOR SAID MINOR: Any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the Medical Practices Act, California Business and Professions Code Section 2000 et seq.; or any x-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care to be rendered by a dentist licensed under the provisions of the Dental Practices Act, California Business and Professions Code Section 1600 et seq.  \nThis authorization is given pursuant to the provisions of California Family Code Section 6910. This authorization shall remain effective until my child completes his/her activities in this program unless sooner revoked in writing. I understand that as a parent/guardian, I will be responsible for the cost of any service or treatment provided.  \nAUTHORIZATION, CONSENT, AND RELEASE  \nI hereby certify that my child is in good health and can participate in all functions of this Program as described above. I am the parent/guardian having legal custody of the youth member named above as stated under California Family Code Section 6550. I understand it is my responsibility to keep the information on this form updated (including Health History) by contacting the Program Staff.  \nSignature of Parent/Guardian Date  \nNON-CONSENT  \nI do not desire to sign this authorization and understand that this will prohibit my child from receiving any non-life threatening medical attention in the event of illness or accident.","cbCaihDHKtI40zF4","https://ap.wps.com/l/cbCaihDHKtI40zF4","pdf",124835,"English","# Authorization, Consent, and Release\n## Authorization for Medical Treatment\n## Non-Consent","[{\"question\":\"What medical care does the authorization cover for a minor?\",\"answer\":\"It covers medical or surgical diagnosis and treatment, including hospital care deemed advisable and supervised by licensed physicians or dentists, plus related procedures such as x-ray examinations and anesthesia as needed.\"},{\"question\":\"How long is the consent effective?\",\"answer\":\"The authorization remains effective until the child completes activities in the program, unless revoked sooner in writing.\"},{\"question\":\"What happens if the parent/guardian chooses non-consent?\",\"answer\":\"Non-consent prohibits the minor from receiving any non-life-threatening medical attention in the event of illness or accident.\"}]","Medical Treatment Authorization Form - for a Minor - Youth Program/Activity | PDF",1789633927]