AUTHORIZATION FOR MEDICAL SERVICES I/We of the child(ren) stated in this form, hereby designate the program leader or his/her designee to act in my behalf to authorize such hospitalization, medical attention, and/or surgery as may be required in an emergency because of illness or injuries sustained by my/our child/ward while participating in RIS Children Program activities. I/We hereby assume financial responsibility for hospitalization, medical attention, transportation, and surgery provided. I/We request that I/We be contacted within a reasonable time in the event of illness or injury requiring medical services.