OPTIONAL MEDICAL INFORMATION Sample Clauses

OPTIONAL MEDICAL INFORMATION. Medication my child is taking at present: Family Health Plan carrier number: Family Doctor: Phone Number: As Parent or Guardian, I agree to all of the above stated considerations and conditions. Signature: Date: MEDICAL MATTERS: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. (Of the following statements pertaining to medical matters, sign only those that are applicable.)
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OPTIONAL MEDICAL INFORMATION. Medication my child is taking at present: Allergies: Other Medical Conditions: Family Health Plan carrier name and number: Family Doctor: Phone Number: As Parent or Guardian, I agree to all of the above stated considerations and conditions: Signature: Date: Contact Alyssa (Youth Minister) at xxxxxx.xxxxxx@xxxxxxxxxx.xxx or 000-000-0000 with any questions. Additional disclosure: CHURCH OF ST. XXXXXXXXXX DISCLOSURE, AUTHORIZATION, CONSENT AND RELEASE FOR SOCIAL MEDIA OR OTHER ELECTRONIC COMMUNICATION INVOLVING MINORS I am the parent or legal guardian of (full name of minor) (“My Child”). I certify that My Child is at least 11 years old. I have been made aware of the Church of St. Wenceslaus Acceptable Use Policy for Electronic Communications and the Social Media Policy of Church of St. Wenceslaus. I authorize staff or other leaders of Church of St. Wenceslaus staff to communicate with My Child electronically, including via social media, text, email and phone in accordance with the Acceptable Use Policy for Electronic Communications. Church Personnel are not required to share non-private communications, such as those sent to youth groups regarding meeting locations or times, or other administrative matters. If any staff or other leaders knowingly communicate privately with a minor as a part of his or her duties for or on behalf of Church of St. Wenceslaus reasonable steps must be taken to send to me the same communication content, not necessarily via the same technology. I acknowledge that to review or receive public communications shared via social media with My Child, I will need to become a fan or follower of the same social media. I understand that communications may be accessible or viewable by others who are also fans or followers of the same social media. AUTHORIZATION, CONSENT AND RELEASE FOR USE OF VISUAL LIKENESSES AND ORIGINAL WORKS OF MINORS I authorize and consent that Church of St. Wenceslaus and the Archdiocese of Saint Xxxx and Minneapolis be permitted to use and publish for general communications, advertising, commercial or publicity purposes, or for any other lawful purpose whatsoever the likeness of My Child and My Child’s original work, including video, photographic portraits, pictures, or reproductions, made through any medium, including social or other electronic media, in accordance with the Acceptable Use Policy for Electronic Communications and the Social Media Policy, provided only the first name (not the family name) is identified i...
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OPTIONAL MEDICAL INFORMATION. Medication my child is taking at present Other Medical Conditions Family Health Plan carrier number Family Doctor Phone Number As Parent or Guardian, I agree to all of the above stated considerations and conditions.
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OPTIONAL MEDICAL INFORMATION. Medication my child is taking at present _____________________________________ Allergies ______________________________________________________________________ Other Medical Conditions_________________________________________________________ Family Health Plan carrier number _________________________________________________ Family Doctor __________________________________ Phone Number __________________
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OPTIONAL MEDICAL INFORMATION. Medication my child is taking at present Family Health Plan carrier number Family Doctor Phone Number As Parent or Guardian, I agree to all of the above stated considerations and conditions. Signature Date CODE OF CONDUCT The following are a few rules that all participants are expected to follow while participating and representing Church of St. Raphael in this event sponsored by Church of St. Raphael on the following dates: Nov. 2, 2019 / Jan. 4, 2020 / Feb. 1, 2020 / Mar. 7, 2020 / Apr. 4, 2020 / May 2, 2020 Please read and sign. I, , WILL: Printed Name of Youth Participant ▪ Treat all other persons with respect and not cause any intentional harm (physically, emotionally, or spiritually) to any person in any way. ▪ Respect the property of others, including all program facilities and property. ▪ Follow all appropriate instructions of all personnel aiding in this event, including, but not limited to, chaperones, support staff, transportation personnel and administration. ▪ Be on time for all check-ins and departure time. ▪ Not have in my possession any tobacco, alcohol or any controlled illegal substance I agree that if any of these terms are violated, Church of St. Raphael can send the participant home at the participant/guardian’s expense. Youth Participant Signature Date Parent/Guardian Signature Date Please return this form to the St. Raphael Youth Ministry Office
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OPTIONAL MEDICAL INFORMATION. Medication my child is taking at present Health conditions my child has **If you have specific health concerns about your child, please speak to Xxxxxx 2739 STI N S O N BOUL E VAR D NOR T HE AS T ¿ ST . ANT HONY ¿ MIN N E S O T A ¿ 55418
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Related to OPTIONAL MEDICAL INFORMATION

  • Medical Information Throughout the Pupil's time as a member of the School, the School Medical Officer shall have the right to disclose confidential information about the Pupil if it is considered to be in the Pupil's own interests or necessary for the protection of other members of the School community. Such information will be given and received on a confidential, need-to-know basis.

  • Technical Information The Employer agrees to provide to the Union such information that is available relating to employees in the bargaining unit, as may be required by the Union for collective bargaining purposes.

  • INITIAL INFORMATION § 1.1 This Agreement is based on the Initial Information set forth in this Section 1.1. (For each item in this section, insert the information or a statement such as “not applicable” or “unknown at time of execution.”)

  • Payroll Information Payroll checks shall include all required information, a clear designation as to the amount and category, e.g., regular, overtime or holiday pay, of compensation for which payment is being made.

  • Proprietary Materials Each of the Parties shall own its own intellectual property including without limitation all trade secrets, know-how, proprietary data, documents, and written materials in any format. Any materials created exclusively by IPS for the School shall be owned by IPS, and any materials created exclusively by Operator for the School shall be Operator’s proprietary material. The Parties acknowledge and agree that neither has any intellectual property interest or claims in the other Party’s proprietary materials. Notwithstanding the foregoing, materials and work product jointly created by the Parties shall be jointly owned by the Parties and may be used by the individual Party as may be agreed upon by both Parties from time to time.

  • Confidential Information and Restricted Activities Employee has entered into the Company’s Employee Proprietary Information Agreement (“EPIA”) and acknowledges his or her obligations thereunder. The EPIA is specifically incorporated into this Agreement.

  • Confidential System Information HHSC prohibits the unauthorized disclosure of Other Confidential Information. Grantee and all Grantee Agents will not disclose or use any Other Confidential Information in any manner except as is necessary for the Project or the proper discharge of obligations and securing of rights under the Contract. Grantee will have a system in effect to protect Other Confidential Information. Any disclosure or transfer of Other Confidential Information by Xxxxxxx, including information requested to do so by HHSC, will be in accordance with the Contract. If Grantee receives a request for Other Confidential Information, Xxxxxxx will immediately notify HHSC of the request, and will make reasonable efforts to protect the Other Confidential Information from disclosure until further instructed by the HHSC. Grantee will notify HHSC promptly of any unauthorized possession, use, knowledge, or attempt thereof, of any Other Confidential Information by any person or entity that may become known to Grantee. Grantee will furnish to HHSC all known details of the unauthorized possession, use, or knowledge, or attempt thereof, and use reasonable efforts to assist HHSC in investigating or preventing the reoccurrence of any unauthorized possession, use, or knowledge, or attempt thereof, of Other Confidential Information. HHSC will have the right to recover from Grantee all damages and liabilities caused by or arising from Grantee or Grantee Agents’ failure to protect HHSC’s Confidential Information as required by this section. IN COORDINATION WITH THE INDEMNITY PROVISIONS CONTAINED IN THE UTC, Xxxxxxx WILL INDEMNIFY AND HOLD HARMLESS HHSC FROM ALL DAMAGES, COSTS, LIABILITIES, AND EXPENSES (INCLUDING WITHOUT LIMITATION REASONABLE ATTORNEYS’ FEES AND COSTS) CAUSED BY OR ARISING FROM Grantee OR Grantee AGENTS FAILURE TO PROTECT OTHER CONFIDENTIAL INFORMATION. Grantee WILL FULFILL THIS PROVISION WITH COUNSEL APPROVED BY HHSC.

  • Statistical Information Any third-party statistical and market-related data included in the Registration Statement, the Time of Sale Disclosure Package and the Prospectus are based on or derived from sources that the Company believes to be reliable and accurate in all material respects.

  • CONFIDENTIAL, PROPRIETARY, AND TRADE SECRET INFORMATION AND MATERIALS a. Buyer and Seller shall each keep confidential and protect from unauthorized use and disclosure all (i) confidential, proprietary and/or trade secret information of a Party or third party disclosed by a Party; (ii) software provided under this Contract in source code form or identified as subject to this Article; and (iii) tooling identified as subject to this Article: in each case that is obtained, directly or indirectly, from the other in connection with this Contract or Buyer’s contract with its customer, if any, (collectively referred to as "Proprietary Information and Materials"). Proprietary Information and Materials excludes information that is, as evidenced by competent records provided by the receiving Party, known to the receiving party or lawfully in the public domain, in the same form as disclosed hereunder, disclosed to the receiving Party without restriction by a third party having the right to disclose it, or developed by the receiving Party independently without use of or reference to the disclosing Party’s Proprietary Information and Materials.

  • Sales Material, Information and Trademarks 6.1 For purposes of this Section 6, "Sales literature or other Promotional material" includes, but is not limited to, portions of the following that use any logo or other trademark related to the Trust, or Underwriter or its affiliates, or refer to the Trust: advertisements (such as material published or designed for use in a newspaper, magazine or other periodical, radio, television, telephone or tape recording, videotape display, signs or billboards, motion pictures, electronic communication or other public media), sales literature (i.e., any written communication distributed or made generally available to customers or the public, including brochures, circulars, research reports, market letters, form letters, seminar texts, reprints or excerpts or any other advertisement, sales literature or published article or electronic communication), educational or training materials or other communications distributed or made generally available to some or all agents or employees in any media, and disclosure documents, shareholder reports and proxy materials.

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