Please select your first and second choice of dates below.
I/We Authorize La Reina High School & Middle School and its delegated adult leaders consent to any medical and hospital care to be rendered to said minor under the advice of a licensed physician. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. It is understood that if time and circumstances permit the adult leader of La Reina High School & Middle School will endeavor, but is not required, to communicate with me prior to such treatment.
The undersigned further agrees that La Reina High School & Middle School and its delegated leaders are not legally or financially liable from any claim arising from any consent given in good faith in connection with such diagnosis or advised treatment.
This authorization and consent to treatment of a minor is given to La Reina High School & Middle School in conjunction with any authorized La Reina High School & Middle School event or program.
A Catholic College Preparatory School for Young Women
Sponsored by the Sisters of Notre Dame
La Reina 106 West Janss Road Thousand Oaks, CA 91360 T 805-495-6494