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Medical and camp contractsx

STUDENT FORM
It is important that you complete and return the following documentation to comply with the School Health and Safety Requirements. We require all parents/caregivers to follow these procedures so that we can maximise the educational value and safety of events. For your own safety please provide us with information that is accurate, current and complete. Please return to the Event Organiser CONTACT DETAILS: (please provide at least 2 sets of contact details) In case of emergency the following should be contacted:
MEDICAL PROFILE AND RISK DISCLOSURE
This Profile is complied to assist us in the care of all participants at events, including adults. Please 1. Please tick if you have any of the following: Diabetes Travel Sickness Fits of any type Chronic nose bleeds Heart Condition Dizzy spells For Overnight Events
2. Are you presently taking tablets and/or medicine? Yes No If 'YES', please state the nature of the ailment, the name of the medication, dosage, etc All student medication must be handed/shown to the Person-in-Charge prior to the event commencing. Medicine must be named, with dosage and time to be taken clearly stated. 3. Have you had any major injuries (breaks or strains) or illness (glandular fever, etc) in the last six months that may limit full participation in any activities? Yes No If 'YES', please state the nature of the injury or illness. If 'YES', please state the nature of the allergy and its preferred treatment. Are you allergic to any of the following: Prescription Medication (e.g. Penicillin) Is there any information the organiser needs to know about you to ensure this event is safe and meaningful for you? i.e. reading difficulties, emotional problems, anxiety, pregnancy, physical If 'YES ', please state or attach the information: I agree that for safety reasons the above information may be passed onto people who require this information in order to make School Events safer. I also agree that if prescribed medication needs to be administered the Teacher-in-Charge (or designated To be read and signed by all Parents/Caregivers
Acknowledgement of Risk
I understand that there are risks associated with involvement in the School Events and that these risks can not be reduced to zero. I also understand that the management of risk is a shared responsibility between the School Staff and Helpers and the participants. I know that I am able to ask the organiser questions about the activities that my child will be involved in, to gain a better understanding of the risks involved. I also recognise that participating in such activities is voluntary on my child's part and is not a required or mandatory activity. If I feel that my child is at risk I may withdraw them after informing the organiser. I understand that the school will identify any hazards that are likely to arise, identify any foreseeable risks and will implement correct management procedures to deal with these hazards. I agree it is incumbent on my child to follow these procedures. Print Name: To be read and signed by all Parents/Caregivers
Please turn over and complete the forms on the back page.
THANK YOU.
CONTRACT WITH STUDENTS

To be read and signed by all participating students
I agree that I will:
Show courtesy and consideration to others
Follow the rules and instructions set down by the organiser/s, staff at the event
Give all activities in the programme a go within 'challenge by choice' options
Look after my personal belongings
I understand that my parents/caregiver will be contacted and I may be sent home if:
My behaviour is considered unacceptable by the organiser or a staff member.
Any of my actions put me or others in danger
Please print name:
CONTRACT WITH PARENTS/CAREGIVERS
I agree that: • My child will participate in the activities outlined in the programme, as long as they are comfortable to do so and set the terms of their own challenges. • In the event of accident or illness, my child will be given such medical assistance as is necessary • That any additional medical costs not covered by ACC or a Community Service card will be paid by me • The School does not accept responsibility for loss or damage to personal property (please check your • My child will accept the rules set by the School for this event • Should my child be involved in a serious disciplinary problem, including the use of illegal substances and alcohol or actions that threaten the safety of anyone at the event, I agree to withdraw him/her or accept she/he may be sent home at my expense.

Source: http://www.hendersonint.school.nz/Cache/Pictures/1697939/Medical_and_camp_contractsx.pdf

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AMENDMENT FOR DISTRIBUTION 11.0--AUTISM NIMH HUMAN GENETICS INITIATIVE DISTRIBUTION AGREEMENT NOW, THEREFORE, it is mutually agreed that the National Institute of Mental Health (NIMH) Human Genetics Initiative Distribution Agreement signed by NIMH, the center for Genetic Studies, and _____________________________________ (PLEASE PRINT) as the Receiving Institution is amended to incl

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