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Consent and Authorization for Emergency Treatment

In 2014, the Wisconsin Alumni Association (WAA) merged with the University of Wisconsin Foundation to create the Wisconsin Foundation and Alumni Association (WFAA), a nonprofit, educational, tax-exempt 501(c)(3) Wisconsin corporation. WFAA is legally registered as the University of Wisconsin Foundation (UWF), but it is also referred to as Wisconsin Foundation and Alumni Association (WFAA) and/or the Wisconsin Alumni Association (WAA). Any reference to WFAA in this document includes UWF and WAA.

I, and any minor (“the Minor”) who accompanies me (all of whom are referred to together as “I” or “my”), wish to participate in the Class of 1971 50-Year Reunion, which will be held October 14-17, 2021, in Madison, Wisconsin (the “Activity”). I certify that I have legal authority to agree to this consent and authorization on my own behalf and/or on behalf of the Minor(s).

I authorize WFAA and WFAA’s designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I AGREE TO BE RESPONSIBLE FOR ALL NECESSARY CHARGES INCURRED BY ANY HOSPITALIZATION OR TREATMENT RENDERED PURSUANT TO THIS AUTHORIZATION.

I HAVE READ THIS CONSENT AND AUTHORIZATION FOR EMERGENCY TREATMENT, I UNDERSTAND ITS TERMS, AND I UNDERSTAND THAT I AGREE TO ITS TERMS BY REGISTERING FOR THE ACTIVITY. I AM EIGHTEEN YEARS OF AGE OR OLDER, I HAVE FULL CAPACITY TO ENTER INTO THIS AGREEMENT ON BEHALF OF MYSELF AND THE MINOR PARTICIPANT(S) AND DO SO VOLUNTARILY.