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Please choose one:
()I will not be appointing a local representative to authorise or refuse consent for any surgery or other medical procedures or treatment on me, on my behalf.
()I appoint the person named below as my local representative* with the authority to authorise or refuse consent for any surgery or other medical procedures or treatment on me, on my behalf.
In so doing, I, for myself, my successors, personal representatives and assigns hereby agree that:
I will not hold the University, its officers, any of its full-time or part-time staff (including student assistants), agents or volunteers responsible or liable in any way for, and no right of action shall arise from, any loss or damage (including, without limitations, personal injury, loss of life or property damage) caused by or sustained as a result of my local representative's authorisation or refusal of consent for any surgery or other medical procedures or treatment.
I will indemnify and keep indemnified, save and hold harmless the University, its officers, any of its full-time or part-time staff (including student assistants), agents or volunteers against all losses, claims, demands, actions, proceedings, damages, costs or expenses, including legal fees, and any other liability arising from my local representative's authorisation or refusal of consent for any surgery or other medical procedures or treatment.
* The local representative to be appointed must be at least 18 years of age.
选哪个。。。谢谢
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