Medical Release Form
My son/daughter(s), has my permission to participate in the STEMBoost Summer STEM Workshops of 2018 at Omei Academy.
I hereby agree to hold harmless the STEMBoost Board of Directors, officers, instructors, volunteers and Omei Academy owner and staff and/or their members with respect to any and all damages or expenses which may be incurred, suffered or required to be paid by reason of this activity before, during or after each workshop.
In the event of illness or injury, I consent to all routine and/or emergency medical treatments and/or services prescribed by the attending doctor, surgeon, dentist or other health care provider and to the administration and performance of all examinations, treatments, anesthetics, operations, and other procedures which are deemed necessary or advisable by the attending doctor at the scene and/or at the hospital or other medical facility.
Below are my child's medical information and statements, and the telephone number where I can be reached, during the workshop(s), should it be necessary to contact me in the event of an emergency.
I hereby agree to hold harmless the STEMBoost Board of Directors, officers, instructors, volunteers and Omei Academy owner and staff and/or their members with respect to any and all damages or expenses which may be incurred, suffered or required to be paid by reason of this activity before, during or after each workshop.
In the event of illness or injury, I consent to all routine and/or emergency medical treatments and/or services prescribed by the attending doctor, surgeon, dentist or other health care provider and to the administration and performance of all examinations, treatments, anesthetics, operations, and other procedures which are deemed necessary or advisable by the attending doctor at the scene and/or at the hospital or other medical facility.
Below are my child's medical information and statements, and the telephone number where I can be reached, during the workshop(s), should it be necessary to contact me in the event of an emergency.
By clicking "Submit", I am agreeing to the statement above and certify that this information is accurate.