Common use of CONSENT FOR MEDICATION ADMINISTRATION Clause in Contracts

CONSENT FOR MEDICATION ADMINISTRATION. To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under the age of 18 while at Xxxx Xxxxxxxx Basketball Camps, LLC, it is camp policy to secure your consent for medication distribution and for the use of medical devices. The medication or medical device can be administered by the Camp Health Supervisor. All medications must be in a medicine bottle and labeled with the camper’s name, doctor’s name and phone number, medication name, and dosage. You must also complete the form below. ❑ No medicationhas been brought to camp. ❑ I wantthemedication or medicaldevicesself-administered (age14 andaboveonly). ❑ I wantthemedication or medicaldeviceadministered bythe Camp Sports Medicine Staff. ❑ However,alimitedamountofmedicationforlifethreateningconditionsmaybecarriedbymyson/daughter/xxxx(e.g., beestingkits,inhalers). Name of Medication(s): Amount of Dosage to be Taken: How is Medication Taken? Time(s) of Day to be Taken: Name of Prescribing Doctor: Doctor’s Phone Number: Special Instructions: Signature of participant (if 18 or older) Date Signature of Parent or Guardian (if Participant is under 18 years old) Date CONSENT FOR MEDICAL TREATMENT: To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under 18 while at our camp, it is our policy to secure your consent for medical treatment. By signing below you are giving your consent in advance for medical treatment at an appropriate medical facility in case of illness or injury. By signing below you are stating that you are aware of and accept the risk inherent in the program activity. Signature of participant (if 18 or older) Date Signature of Parent or Guardian (if Participant is under 18 years old) Date

CONSENT FOR MEDICATION ADMINISTRATION. To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under the age of 18 while at Xxxx Xxxxxxxx Basketball Camps, LLC, it is camp policy to secure your consent for medication distribution and for the use of medical devices. The medication or medical device can be administered by the Camp Health Supervisor. All medications must be in a medicine bottle and labeled with the camper’s name, doctor’s name and phone number, medication name, and dosage. You must also complete the form below. ❑ No medicationhas been brought to camp. ❑ I wantthemedication or medicaldevicesself-administered (age14 andaboveonly). ❑ I wantthemedication or medicaldeviceadministered bythe by the Camp Sports Medicine Staff. ❑ However,alimitedamountofmedicationforlifethreateningconditionsmaybecarriedbymysonalimitedamountofmedicationforlifethreateningconditionsmaybecarriedby my son/daughter/xxxx(e.g., beestingkits,inhalers). Name of Medication(s): Amount of Dosage to be Taken: How is Medication Taken? Time(s) of Day to be Taken: Name of Prescribing Doctor: Doctor’s Phone Number: Special Instructions: Signature of participant (if 18 or older) Date Signature of Parent or Guardian (if Participant is under 18 years old) Date CONSENT FOR MEDICAL TREATMENT: To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under 18 while at our camp, it is our policy to secure your consent for medical treatment. By signing below you are giving your consent in advance for medical treatment at an appropriate medical facility in case of illness or injury. By signing below you are stating that you are aware of and accept the risk inherent in the program activity. Signature of participant (if 18 or older) Date Signature of Parent or Guardian (if Participant is under 18 years old) Date

CONSENT FOR MEDICATION ADMINISTRATION. To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under the age of 18 while at Xxxx Xxxxxxxx Basketball Camps, LLC, it is camp policy to secure your consent for medication distribution and for the use of medical devices. The medication or medical device can be administered by the Camp Health Supervisor. All medications must be in a medicine bottle and labeled with the camper’s name, doctor’s name and phone number, medication name, and dosage. You must also complete the form below. ❑ No medicationhas medication has been brought to camp. ❑ I wantthemedication want themedication or medicaldevicesselfmedical devicesself-administered (age14 andaboveonlyadministered(age 14 and aboveonly). ❑ I wantthemedication want the medication or medicaldeviceadministered bythe medical device administered by the Camp Sports Medicine Staff. ❑ However,alimitedamountofmedicationforlifethreateningconditionsmaybecarriedbymyson, alimitedamount of medicationfor life threateningconditionsmay be carried by my son/daughter/xxxx(e.g., beestingkits,, inhalers). Name of Medication(s): How is Medication Taken? Name of Prescribing Doctor: Amount of Dosage to be Taken: How is Medication Taken? Time(s) of Day to be Taken: Name of Prescribing Doctor: Doctor’s Phone Number: Special Instructions: Signature of participant (if 18 or older) Date Signature of Parent or Guardian (if Participant is under 18 years old) Date CONSENT FOR MEDICAL TREATMENT: To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under 18 while at our camp, it is our policy to secure your consent for medical treatment. By signing below you are giving your consent in advance for medical treatment at an appropriate medical facility in case of illness or injury. By signing below you are stating that you are aware of and accept the risk inherent in the program activity. Signature of participant (if 18 or older) Date Signature of Parent or Guardian (if Participant is under 18 years old) DateDate Camper’s Name __________________________________________ PART ONE CONTINUED:

CONSENT FOR MEDICATION ADMINISTRATION. To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under the age of 18 while at Xxxx Xxxxxxxx Basketball Camps, LLCthe University of Wisconsin-Milwaukee, it is camp policy to secure your consent for medication distribution and for the use of medical devices. The medication or medical device can be administered by the Camp Health Supervisor. All medications must be in a medicine bottle and labeled with the camper’s name, doctor’s name and phone number, medication name, and dosage. You must also complete the form below. ❑ No medicationhas medication has been brought to camp. ❑ I wantthemedication want the medication or medicaldevicesselfmedical devices self-administered (age14 andaboveonlyage 14 and above only). ❑ I wantthemedication want the medication or medicaldeviceadministered bythe medical device administered by the the Camp Sports Medicine Staff. ❑ However,alimitedamountofmedicationforlifethreateningconditionsmaybecarriedbymyson, a limited amount of medication for life threatening conditions may be carried by my son/daughter/xxxx(e.g.xxxx (e.g.,bee sting kits, beestingkits,inhalers). Name of Medication(s): How is Medication Taken? Name of Prescribing Doctor: Amount of Dosage to be Taken: How is Medication Taken? Time(s) of Day to be Taken: Name of Prescribing Doctor: Doctor’s Phone Number: Special Instructions: Signature of participant (if 18 or older) Date Signature of Parent or Guardian (if Participant is under 18 years old) Date CONSENT FOR MEDICAL TREATMENT: To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under 18 while at our camp, it is our policy to secure your consent for medical treatment. By signing below you are giving your consent in advance for medical treatment at an appropriate medical facility in case of illness or injury. By signing below you are stating that you are aware of and accept the risk inherent in the program activity. Signature of participant (if 18 or older) Date Signature of Parent or Guardian (if Participant is under 18 years old) Date