In case of emergency, and if I/we cannot be reached, I/we the undersigned parent(s) or guardian(s) of the above named student, a minor, do hereby authorize a representative of The Hillside School and Learning Center and/or the alternates listed above to act as agent(s) to consent to any X-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care deemed advisable and rendered by any licensed physician or surgeon, whether in his/her office or in a licensed hospital. This authorization is given in advance of any required care to empower a representative or official of the The Hillside School and Learning Center to give consent for such treatment as the physician may deem advisable. I/we understand that The Hillside School and Learning Center does not provide accident medical insurance for students for school-related injuries.