MEDICAL EMERGENCY PARENTAL PERMISSION. I understand that my child must be healthy and reasonably fit in order to safely participate in Crop Scouting Competition 2016 activities. My child or I will inform the program leader(s) of any medication, ailment, condition, or injury that may affect his/her ability to participate safely. If an injury or other medical condition occurs or arises, I hereby give permission to the ISU representatives to provide routine first aid and seek emergency treatment including X-rays or routine tests. I agree to the release of any record necessary for treatment, referral, billing or insurance purposes. I understand that I am financially responsible to the attending physicians or health care unit. In the event of an emergency where the Emergency Contact listed above cannot be reached, I give permission to the physician/hospital selected by ISU representatives to secure and administer treatment for my child, including hospitalization. INSURANCE INFORMATION: ISU does not provide health insurance for participants in this event/activity. Yes The above-named participant is covered by health insurance. No If no, initial this line stating that you do not have health insurance and are aware that Iowa State University does not carry any health insurance for you.
MEDICAL EMERGENCY PARENTAL PERMISSION. I understand that my child must be healthy and reasonably fit in order to safely participate in Buggin Out Summer Day Camp activities. My child or I will inform the program leader(s) of any medication, ailment, condition, or injury that may affect his/her ability to participate safely. If an injury or other medical condition occurs or arises, I hereby give permission to the Entomology Department/ISU representative to provide routine first aid and seek emergency treatment including X-rays or routine tests. I agree to the release of any record necessary for treatment, referral, billing or insurance purposes. I understand that I am financially responsible to the attending physicians or health care unit. In the event of an emergency where the Emergency Contact listed above cannot be reached, I give permission to the physician/hospital selected by an ISU representatives to secure and administer treatment for my child, including hospitalization. INSURANCE INFORMATION: ISU does not provide health insurance for participants in this event/activity. ❒ Yes The above-named participant is covered by health insurance. ❒ No If no, initial the line below stating that you do not have health insurance and are aware that Iowa State University does not carry any health insurance for you.
