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Unaccompanied Minor Waiver

Any minor (under 18 years) not coming with their parent or guardian must fill out this waiver. 

If the minor is being accompanied by their parent or guardian they can complete the www.smartwaiver.com/v/arcgfamilyadult

Call us at 707-874-3507 if you have any questions! 

 

 

Alliance Redwood Conference Grounds Waiver 

Medical and Liability Release

I agree to allow the ALLIANCE REDWOODS CONFERENCE GROUNDS Health Care Staff to render care to, arrange transportation for and administer over-the-counter medications to, the named minor, within the Staff scope of practice, and as deemed beneficial to the health and well- being of the named minor. I further agree that the over-the-counter and prescription medications, brought to camp will be collected by and then only administered by, the ALLIANCE REDWOODS CONFERENCE GROUNDS Health Care Staff, in accordance with all applicable prescriptive direction and/or on an as needed basis. No medications having reached an expiration date will be accepted or administered.

In the event I cannot be reached by phone at the time of an injury or illness to the named minor, I hereby give, as parent/legal guardian, my permission to the doctor selected by the ALLIANCE REDWOODS CONFERENCE GROUNDS to hospitalize, access and procure necessary medical records, and secure appropriate treatment, including but not limited to, injections, anesthesia, testing, radiology, or surgery for the named minor as deemed necessary. Medical insurance coverage by the ALLIANCE REDWOODS CONFERENCE GROUNDS’ insurer is secondary to your medical insurance policy, and available only following the usage of your policy to the limit of your policy coverage or if you have no medical insurance of your own.

I understand that in signing this form that I am providing both a Medical and Liability Release to the ALLIANCE REDWOODS CONFERENCE GROUNDS for the minor named on the front page. I hereby acknowledge that during his/her attendance at a camp session certain risks exist, which may be known or unknown at this time, and may result in physical injury or illness. In signing this Liability Release, I assume full responsibility for mitigation of such an incident, and I am granting permission for the participation of the named minor in all session related activities, unless specifically noted on this form. This release is intended to stand on the behalf of the named minor, and in place of all claims by any family member or agent. These releases of ALLIANCE REDWOODS CONFERENCE GROUNDS shall be in effect only for the duration of the camp session as indicated, and only while the named minor is on the grounds of ALLIANCE REDWOODS CONFERENCE GROUNDS, and/or under the direct supervision of ALLIANCE REDWOODS CONFERENCE GROUNDS employees.

I agree that, in the event of dispute between myself as guest or parent/legal guardian of, or on behalf of, the named minor, I will submit to arbitration by an organization sanctioned for this purpose, in lieu of pursuing litigation in a court of law. I further agree as parent/legal guardian, to absolve and hold harmless the ALLIANCE REDWOODS CONFERENCE GROUNDS a Non-profit Corporation, its Board of Directors and Trustees, agents and employees against liability for; damages, losses, or injuries or illnesses to; myself, my property, or the named minor.

Non-compliance with disclosed behavioral standards and instructions, written or oral, may result in disciplinary actions, up to and including, being asked to remove the named minor from the grounds. Anyone asked to leave the grounds shall forfeit all camp fees previously paid, while remaining liable for any fees due.

I hereby give my permission to the ALLIANCE REDWOODS CONFERENCE GROUNDS to use photography of the named minor taken while on the grounds for promotional purposes. 

WAIVER AND RELEASE OF LIABILITY

In consideration of The Alliance Redwoods Conference Grounds furnishing services and/or equipment and/or using my own equipment to enable me to participate in ropes course, biking, kayaking, canoeing, rock climbing, skateboarding, inline skating, scooters, paintball games or any other activities, I agree as follows:

I FULLY UNDERSTAND AND ACKNOWLEDGE THAT:

A) Risks and dangers exist in my use of the equipment and my participation in the activities stated above;

B) My participation in such activities and/or use of such equipment may result in injury or illness including, but not limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability;

C) These risks and dangers may be caused by the negligence of the owners, employees, officers, or agents of The Alliance Redwoods Conference Grounds; the negligence of the participants, the negligence of others, accidents, breaches of contract, the forces of nature or other causes. These risks and dangers may arise from foreseeable or unforeseeable causes; but not limited to, guide decision making, including that a guide may misjudge terrain, weather, faulty equipment, trail or river route location, and water level, risks of falling out of or drowning while in a raft, canoe or kayak and such other risks, hazards and dangers that are integral to recreational activities that take place in a wilderness, outdoor or recreational environment;

D) And by my participation in these activities and/or use of equipment, I hereby assume all risks and dangers and all responsibilities for any losses and/or damages, whether caused in whole or in part by the negligence or other conduct of owners, agents, officers, or employees of The Alliance Redwoods Conference Grounds, or by any other person.

I, on behalf of myself, my personal representatives, and my heirs hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify The Alliance Redwoods Conference Grounds and its owners, agents, officers and employees from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my participation in any of the activities stated above, or any other activities. I specifically understand that I am releasing, discharging, and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the owners, agents, officers or employees of The Alliance Redwoods Conference Grounds.

I have read this waiver and release of liability and by signing it agree, it is my intention to exempt and relieve The Alliance Redwoods Conference Grounds from liability for personal injury, property damage or wrongful death caused by negligence or any other cause. I also understand that in signing as a parent or guardian in the event of an emergency if I can not be reached, I hereby give permission to the physician selected by The Alliance Redwoods Conference Grounds staff to hospitalize or to secure proper treatment, order injections, anesthesia or surgery for my child. 

I Agree
 

 February 21, 2019

 

First Guest Name

First Name*

Last Name*

Phone*
First Guest Date of Birth*
First Guest Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
First Guest Signature*
Second Guest Name

First Name*

Last Name*
Second Guest Date of Birth*
Second Guest Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
Third Guest Name

First Name*

Last Name*
Third Guest Date of Birth*
Third Guest Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
Fourth Guest Name

First Name*

Last Name*
Fourth Guest Date of Birth*
Fourth Guest Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
Fifth Guest Name

First Name*

Last Name*
Fifth Guest Date of Birth*
Fifth Guest Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
Sixth Guest Name

First Name*

Last Name*
Sixth Guest Date of Birth*
Sixth Guest Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
Seventh Guest Name

First Name*

Last Name*
Seventh Guest Date of Birth*
Seventh Guest Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
Eighth Guest Name

First Name*

Last Name*
Eighth Guest Date of Birth*
Eighth Guest Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
Ninth Guest Name

First Name*

Last Name*
Ninth Guest Date of Birth*
Ninth Guest Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
Tenth Guest Name

First Name*

Last Name*
Tenth Guest Date of Birth*
Tenth Guest Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
Guest Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Select Your Group:
02/15-02/17 OUR LADY OF PERPETUAL HELP RELIGIOUS EDUCATION
02/15-02/18 MOUNTAIN VIEW CHINESE CHRISTIAN
02/16-02/18 SOUTH BAY AGAPE CHRISTIAN CHURCH
02/22-02-24 ST. BONAVENTURE
03/01-03/03 HSFS HOLY SPIRIT FILIPINO SOCIETY
03/07-03/08 ST. PATRICK/ST. VINCENT CATHOLIC HIGH SCHOOL
03/15-03/16 SALESIAN HIGH SCHOOL
04/05-04/07 JOYFUL CHURCH
04/06-04/07 ROCK OF SALVATION FAMILY CENTER
04/18-04/19 ROSELAND UNIVERSITY PREP
04/26-04/28 HOME CHURCH
06/14-06/16 CALVARY FELLOWSHIP DISCOVERY BAY
07/26-07/28 FLY FRESHLIFE LINES
08/02-08/04 ROHNERT PARK CHRISTIAN CHURCH
08/16-08/18 BERKELEY GRACE PRESBYTERIAN
10/18-10/20 TRUE PENTECOSTAL CHURCH
Emergency Contact:

Name *

Relationship

Phone Number *

Address
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above. If minors are coming without their parent, send all prescription medication in a bag with our "Medical Procedures and Check In" form. Our First Aid team will administer prescribed medication to minors. Please do not send over the counter medicine with your minors, the First Aid team can provide these for minor when needed.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information:

SPECIAL MENU REQUEST: 

The ARCG Dining Hall has 3 special menus. You may select only one special menu to eat during your entire stay. 

There is an additional charge of $3 per person, per meal for these special menus. When you select one of the special menus your group leader will be notified. Please coordinate payment with your leader.

Please select a special menu option below:*
Standard Menu - No additional charge
Gluten Free option at all meals - Up Charge
Vegan option at all meals - Up Charge
Vegetarian option at all meals - Up Charge

MINOR HEALTH HISTORY INFORMATION: 



Please list any allergies, indicating if you have an epi-pen:

Please list any medicine (over the counter or prescribed) that should NOT be given:
Please check any condition(s) that apply:
Diabetes
Headache
Heart Condition
Seizures
Asthma
Fainting
Nose Bleeds

Please list any medical concerns or restrictions:

Please list any Physical Disabilities or Restrictions:
Will you be bringing prescription medication to camp?

If yes, you are bringing prescription medication to camp. 

Please complete our "Medical Procedures and Check In" form and send it with the medication. It can be found at http://www.allianceredwoods.com/pdfs/ODEForm-MedicationCheckInForm.pdf 

These are the three closest hospitals to camp. In case of emergency which one would you like us to direct first responders to:

Date of last Tetanus shot:

Medical Insurance Company & Policy Number:

Physician/Clinic Name & Phone Number:

Dental Clinic Company & Policy Number:

Dentist/Office Name & Phone Number:

Adult/Guardian's Occupation & Employer:
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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