THSC SW CONVENTION & FAMILY CONFERENCE SPECIAL BUDDIES REGISTRATION FORM

July 24 - 26, 2014 ~ The Woodlands, Texas

The Special Buddies Program (SBP) is available to individuals with special needs on a case-by-case basis and while space is available. The SBP reserves the right to recommend other options, possibly including the Children’s Program, if an individual does not fall within the parameters of the SBP. For security purposes and because of the personalized care offered through the Special Buddies Program, please email a recent picture of your loved one to specialbuddiesjoy@gmail.com. In the subject field, please put “SBP 2014” followed by your loved one’s last name.

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    Positive Atlanto-axial Instability Results

    Positive indication is the atlanto-dens interval is 5mm or more. I understand that if an individual has Down syndrome, he/she cannot participate in activities which by their nature result in hyper-extension, radical flexion or direct pressure on the neck or upper spine. By signing this form, I expressly warrant that this individual named above, is capable of withstanding both the physical and mental demands of various play activities. I understand that the convention center is not specifically designed for individuals with special needs. I further understand that, in the event the individual requires medical or dental treatment while engaged in the activity, reasonable efforts will be made to contact me; however, if I cannot be reached, I hereby consent and give permission to the ministry’s Director or any adult volunteer leader acting on behalf of the ministry with respect to the activity, as an agent for me, to consent to any X-Ray examination; injections; anesthesia; medical, dental, or surgical diagnosis and treatment; and hospital care and treatment advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either as an outpatient or in any hospital. To the best of my knowledge, I have listed above all of the individual’s medical allergies, medications being taken, medical problems, and other pertinent information. The individual has permission to participate in all prescribed activities except as noted by me.
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