AUTHORIZATION OF CONSENT TO TREAT MINOR 

I/We, the Parents/Guardians listed below, are the ___ parent(s) / ___ guardians of the Student listed below, and as such do hereby authorize the School named below and its employees, contractors, and adult volunteers as our agent(s) (collectively, “School”) to consent to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment or hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of, any physician or surgeon licensed under the laws of the jurisdiction where such diagnosis or treatment may be given, whether such diagnosis or treatment is rendered at the office of said physician, at a hospital, or at any other location.

I/we understand that this authorization is given in advance of any specific treatment or diagnosis, but is given to provide authority and power of treatment or hospital care which the aforementioned physician in the exercise of best judgment may deem advisable. This authorization is given pursuant to the provisions of Chapter 32 of the Texas Family Code. This authorization shall remain effective for up to one year from the date of completion of this form, unless sooner revoked in writing delivered to said agent(s). 

In consideration of acceptance of this authorization, but without any time limitation and without any future right of revocation, I/we hereby release and agree to fully and unconditionally protect, indemnify, and defend School, the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, “Indemnitees”) and hold each Indemnitee harmless from and against any and all costs, expenses, attorney’s fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons (including Student) and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to such treatment, treatment decisions, diagnosis, or hospital care relating to Student, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES.