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Baldwin Wallace University Advisory
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Participant Waiver Form
Acceptance of Health Service Emergency Treatment
Child's Name
*
Child's Age
*
If my child should become ill or injured during camp, I DO HEREBY GIVE MY PERMISSION for my child to receive all necessary medical attention if the need arises, including permission for my child to be transported to and seen and/or treated by the nearest hospital in the vicinity of the event. Need shall be determined solely at the discretion of the emergency medical provider and/or the professional staff supervising or coordinating the activity, trip or event.
SIGNATURE OF PARENT/GUARDIAN
*
clear
RELATIONSHIP TO CHILD
*
DATE (MM/DD/YYYY)
*
Participant Must Have Medical Insurance
Name of Insurance Company
*
Group Number
*
Policy Number
*
Name of Policy Holder
*
Relationship to Participant
*
Photo Release
I authorize Baldwin Wallace University to use photographs of my child and his/her work for promotional purposes which may include Baldwin Wallace University online and print publications or submission to the press for use in articles or advertisements.
*
Yes
No
PARENT/GUARDIAN SIGNATURE
*
clear
DATE (MM/DD/YYYY)
*