In case of an emergency occurring during a 2008 KWGA golf event, if either parent or guardian can not be reached, a qualified and licensed medical doctor is authorized to take all necessary measures in the treatment of:

First Name MI

Last Name

Birth Date (M/D/Y)

Parent(s) Name

Address City Zip

Home Phone Work Phone

Cell Phone(s)

Family Physician Name

Physician's Phone

Other Contacts in Case of Emergency:

Name

Phone

Name

Phone

I give permission to KWGA personnel or their representative to arrange transportation of my child to the nearest hospital emergency room should such care be deemed necessary.

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