Emergency Consent Form

for (students name)______________________

I, the understand parent or legal guardian of above named child will not hold Cambridge Center for Chinese Culture(the CCS), its agents, servant or employees responsible for any accidents incurred during participation in the CCS programs. If parents or doctor cannot be reached in case of emergency, content is hereby given that the student receives medical treatment.

Date____________________ Parents and Guardian's Signature_____________________

Child's Doctor Name________________ Doctor's Phone No.________________________

* Please print this out and send this form to the CCS with your application form together.