"I, as the primary parent/guardian of the student listed in this document, give permission for the student to receive emergency medical treatment and to be hospitalized, if necessary. I further give permission for the student listed in this document to receive any medical attention as deemed necessary by qualified medical personnel in the event such medical attention is necessary. I give my permission for the student listed in this document to receive medications prescribe by a physician or other qualified medical personnel in the event of a sudden ilness or injury. I understand that every effort will be made to contact the emergency contact listed on the health forms, prior to taking that action. I understand that Southwestern Oklahoma State University, the SWOSU Dawg HOUSE Academy, and their respective past, present, and future employees, affiliates, associates, volunteers, directors, representatives, sponsors, participants, and guests do not provide any accident or medical insurance for the student listed in this document under the SWOSU Dawg House Academy program. I agree that I am financially responsible for any and all medical, dental, or hospital care expenses associated with the student listed in this document as a result of participation in any activities at or sponsored by the SWOSU Dawg HOUSE Academy."
"As the primary parent/guardian of the student listed in this document, I verify that the health history and other medical and medication information as given in these forms are complete and accurate to the best of my knowledge. The student listed in this document is able to take part in all prescribed activities unless otherwise noted in this document. Any changes to this information will be shared in writing by me or in a private consultation with the Academy Director or other designated health care professional. I understand that any medical information collected by the SWOSU Dawg HOUSE Academy for the purpose of Academy attendance will only be shared with the Academy representatives assigned to care for the student. This information will only be shared in the instance that it is necessary to keep the student safe. Academy personnel will be made aware of the necessity to ensure the privacy of medical information. Documents with personal and medical information will be stored in a locked and secured location."
"I (as the primary parent/guardian of the student listed in this document) understand that, even when every reasonable precaution is taken, accidents and unexpected illness can sometimes occur. I am fully aware that there are inherent risks involved with program activities, and I choose to allow my student to voluntarily participate in said activity with full knowledge that said activity may be hazardous to them (including paralysis, dismemberment, and death), as well as may cause loss of or damage to their personal property. I also understand my student assumes full responsibility to work safely during activities, to avoid unnecessary risk, and accept responsibility for safety to prevent injury to themself and others. I understand and expressly acknowledge that I, for myself, my student, and anyone entitled to act on my behalf, hold harmless Southwestern Oklahoma State University, the SWOSU Dawg HOUSE Academy, and their respective past, present, and future employees, affiliates, associates, volunteers, directors, representatives, sponsors, participants, and guests for any and all claims of liabilities, injuries, losses, costs, damages, attorney's fees, and expenses of any kind my student may sustain or incur as a result of participation in the SWOSU Dawg HOUSE Academy."
"I understand that Southwestern Oklahoma State University is committed to the principles of equal access and opportunity for persons with disabilities in compliance with the Americans with Disabilities Act of 1990 (ADA) and Section 504 of the Rehabilitation Act of 1973. As such, the SWOSU Dawg HOUSE Academy does not discriminate on the basis of disability against any qualified person with a disability in regard to application, acceptance, hiring, attendance, or other aspect of a person's participation in the Academy. I understand that the SWOSU Dawg HOUSE Academy Accommodation Policy describes an interactive relationship between myself (as the primary parent/guardian of the student listed in this document), my student, and SWOSU Dawg HOUSE Academy staff. The SWOSU Dawg HOUSE Academy staff will make a reasonable accommodation for a qualified person with a disability to allow the performance of the essential requirements of the Academy. The SWOSU Dawg HOUSE Academy staff will not make an accommodation if the accommodation alters the nature of the program or would result in undue hardship to the College/University or threaten the health and safety of the person with a disability or other persons involved in the Academy. I understand the Academy Director and Southwestern Oklahoma State University have the exclusive authority to make the final decision as to whether my student can be accommodated."
"I (as the parent/guardian of the student named in this document) deem Southwestern Oklahoma State University, the SWOSU Dawg HOUSE Academy, and their respective past, present, and future employees, affiliates, associates, volunteers, directors, representatives, sponsors, participants, and guests as not responsible for items lost or stolen during the Academy at SWOSU. This includes but is not limited to: jewelry, radios, iPods, tablets, cell phones and any other articles of value brought to or acquired while at Academy."
Price:
$25.00