Temporary Guardianship Waiver

Hidden Falls Adventure Park & Copperhead Creek Shooting Club
Authorization of Temporary Guardianship and Consent to Medical Treatment by Nonparent 

  1. By my signature hereto, I hereby give authority to the “Temporary Guardian” (named below) to consent to medical and/or dental treatment for the Child in the event I cannot be contacted. The Temporary Guardian is an adult who has the care and control of the Child.

  2. Without limitation, any physician, surgeon, hospital or medical staff, emergency ambulance personnel and/or dentist may receive the consent hereby given in this authorization.

  3. The date treatment is to begin is the date upon which the Temporary Guardian requests treatment be performed.

  4. I acknowledge that the Child will reside with the Temporary Guardian and may travel locally with the Temporary Guardian and participate in off road and other outdoor motorized activities at Hidden Falls Adventure Park and/or shooting sports at Copperhead Creek Shooting Club, located at 7030 E. FM 1431, Marble Falls, Texas 78654.

  5. I authorize the Temporary Guardian to act on my behalf in making all decisions on a daily basis as to the Child’s activities, well-being and welfare.

  6. I authorize the Temporary Guardian to administer general first aid treatment for minor injuries or illnesses experienced by the Child except where any such first aid treatment is specifically excluded hereunder:


This authorization may be executed by electronic signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature. Without limitation, “electronic signature” shall include faxed versions of an original signature or electronically scanned and transmitted versions (e.g., via pdf) of an original signature.

Signee Information

Information of the temporary guardian(s) are:

Enter date that authorization terminates

The Child’s medical insurance information is:

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.