AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT OR SURGERY

We understand that because students enrolled in St. Mary's University's Study Abroad Programs are out of the United States for prolonged periods, occasions may arise when sickness or accident require routine or emergency medical or surgical treatment.

We further understand that a physician or medical or surgical treatment facility often will require that some adult person be in a position to give an authorization to render the medical or surgical service, and to give reliable assurance that payment for such services will be made.

Accordingly, to help assure that the student identified below is not precluded from receiving needed treatment, each of us (the student and the student's parent[s] or guardian[s]) desires to authorize St. Mary's University and its agents and employees to obtain for the student needed medical and surgical services. Also, we desire to assure St. Mary's University that we will see to it that the charges for such services that may be arranged for by the University, or its Program Director, will be paid by us if medical insurance provided by the program does not fully cover all such charges.

1. Each of us (student and parent[s] or guardian[s]) authorizes St. Mary's University and any agent or employee thereof to provide or arrange for the providing of such medical and surgical services as may seem to it necessary and proper during such time as the student is enrolled in the identified Study Abroad Program. Each of us also authorizes release of the student's appropriate medical records to attending physicians.
2. Each of us (student and parent[s] or guardian[s]) agrees to pay such fees and charges as may result from the provision of such medical and surgical services and to reimburse St. Mary's University, its agents and employees, for any fees or other expenses it or they might reasonably incur should it or they be required to pay any such fees or charges or other costs incidental to the providing of such services.

We understand that normally the University will notify the parents in advance of any unusual medical or surgical procedure that may be required by the student, but agree that no such advance notice is expected unless it may be practically and conveniently given.