Salesian Shadow Program

---

 

---

 

I, the undersigned, as parent/legal guardian of the named student, a minor, do hereby authorize a representative of Salesian College Preparatory as agent for the undersigned to consent to any medical or surgical diagnosis or treatment and hospital care deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the California Medicine Practice Act on the medical staff of an accredited hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis treatment or hospital care being required but is given to provide authority and power on the part of Salesian College Preparatory to give specific consent to any and all such diagnosis, treatment or hospital care that the above mentioned physician in the exercise of his or her best judgment may deem advisable.