Convention - Adult Form

I hereby release Colorado DeMolay from all responsibility and liability for any illness or injury that I may sustain during this activity. In the event of an emergency, I hereby authorize an adult leader of this activity as agent for me, to consent to any x-ray examination, medical, dental or surgical diagnosis, treatment and hospital care advised and supervised by a physician, surgeon, dentist (as appropriate), licensed to practice under the laws of the state where services are begin rendered, either at a Doctor's office or in any hospital.