ACTIVITY CONSENT FORM AND APPROVAL BY PARENTS OR LEGAL GUARDIAN

The recommended use of this form is for the consent and approval for Kadampa Center Members, volunteers and guests to participate in the 2019 Spring Campout.

PLEASE NOTE THAT A PARENT OR GUARDIAN MUST ACCOMPANY ALL MINORS ON THIS EVENT.

INFORMED CONSENT, RELEASE AGREEMENT, AND AUTHORIZATION
I understand that participation in Kadampa Center activities involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges in the activities offered. Information about those activities may be obtained from the venue, or activity coordinators, or center management. I also understand that participation in these activities is entirely voluntary and requires participants to follow instructions and abide by all applicable rules and the standards of conduct. In case of an emergency involving my child/ren, I understand that efforts will be made to contact me (if not present). In the event I cannot be reached, permission is hereby given to the medical provider to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose protected health information to the adult in charge and/ or any physician or health care provider involved in providing medical care to the participant. Protected Health Information/Confidential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.

With appreciation of the dangers and risks associated with programs and activities, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against the Kadampa Center, the activity coordinators, and all volunteers, related parties, or other organizations associated with any program or activity.