Tulsa

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I have carefully read and understand the above Special Needs Health Center Inc. policies. I agree with the policies and will inform my camper of the rules and policies of camp. (Initial using your mouse or touchscreen.)

I understand that Special Needs Health Center Inc. is NOT responsible for loss of clothing or personal property while at events. I agree to bring all articles of clothing and personal property clearly marked with my first and last name. I understand that part of the day camp experience involves activities, group social arrangements and interactions. These activities and interactions may come with certain risks or uncertainties, and I am aware of these risks. I realize that no environment is risk-free, and I understand risks are minimized when following the rules as instructed by the camp staff. These rules are made to insure safety for all and I agree to follow all rules. I hereby, and for my heirs, executors, and administrators, assigns and all legal guardians, waive and release any and all rights and claims of any nature I may have against Special Needs Health Center Inc., its directors, collectively and individually, employees, Board of Directors, coaches, campers and cooperating entities for and against any and all injuries and damages of any nature, including death, which I may suffer while taking part in Special Needs Health Center Inc. Day Camp or other activities associated with Special Needs Health Center Inc. I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH THE Special Needs Health Center, INC., RELEASE OF LIABILITIES. (Initial using your mouse or touchscreen.)

I hereby give permission to the physician selected by the Camp Director to order routine medical tests, X-rays, and treatment for emergency health concerns in the event that the parent/guardian cannot be reached. I give the members of the camp medical team permission to administer over-the-counter medications as needed and to give scheduled medication as ordered on the Medication Instruction Form. I realize the camp has a limited liability medical policy for volunteers with a $2,500 maximum limit, covering only trauma, not illness. Any medical expenses in excess of this amount will be my responsibility. I authorize any physician, nurse or other health care provider to communicate with the camp medical staff and any Director of Special Needs Health Center, or his/her designee, concerning my medical condition, treatment and/or prognosis. I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH THE Special Needs Health Center, INC., MEDICAL AUTHORIZATION AND PRIVACY AGREEMENT. (Initial using your mouse or touchscreen.)

I realize that photographs and films of camp activities may be taken and used for fund-raising and publicity purposes. I hereby give my consent to Special Needs Health Center Inc., its officers, employees, agents, chapters, assignees, licensees and cooperating entities, to use my picture, name, portrait, likeness, writings or biographical information, and/or audio tape for editorial, educational, promotional and advertising purposes, for the solicitation of contributions and for any other purposes in furtherance of the corporate purposes and objectives of Special Needs Health Center, Inc. This release and consent shall be binding upon my child’s heirs, executors, administrator, assigns, and all legal guardians of my child. I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH THE Special Needs Health Center, INC., MEDIA RELEASE. (Initial using your mouse or touchscreen.)

I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH ALL POLICIES AND STATEMENTS IN THIS Special Needs Health Center, INC., VOLUNTEER REGISTRATION FORM. (Add your signature below with your mouse or touchscreen.)

I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH ALL POLICIES AND STATEMENTS IN THIS Special Needs Health Center, INC., VOLUNTEER REGISTRATION FORM. (Add your signature below with your mouse or touchscreen.)