Health Statement Sample Clauses

Health Statement. I acknowledge my Child is in excellent health and physical condition. I have disclosed any medical, physical, or mental health condition to Wanna Play Playcare in my Child’s Enrollment Form.
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Health Statement. My child is in good health, with activity restrictions noted on the child information record. My child’s immunizations are up-to-date and on file with the school and/or appropriate waiver are on file with the school.
Health Statement. If my child needs the following, I authorize school personnel to administer (check all that apply) Acetaminophen (Tylenol) Ibuprofen (Advil/Motrin) Administration of “over the counter” medication will be at the discretion of the appointed personnel, consistent with the recommended does for age as defined on package guidelines. I agree to allow personel to administer over the counter medication as needed. Is the student diabetic? If Yes, is the student insulin-dependent? List all allergies (including food, medicines, vaccines, environmental, etc.) IF NO ALLERGIES, PLEASE STATE “NONE”: Special instructions if exposed to allergen: List any serious Illness, surgery, or injury of this past year: List any other medical problems (Include details on a separate sheet if necessary): Does the child currently wear: If you cannot be contacted in an emergency, please designate who to contact next: Emergency Contact Name Emergency Contact Phone # Cell Phone # Relationship
Health Statement. The proposed activity provided by the Angelina College Ropes Course, requires participation in physical exercises, which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart related or other diseases. Therefore, all participants must be free of medical or physical conditions, which might create undue risk to themselves or any others who depend on them. Good physical condition will increase your enjoyment of the outdoor activities. If there is any doubt about your ability to safely participate in the experience, you should have a physical examination.
Health Statement. Neither Camper nor anyone in Xxxxxx’s immediate family has suffered from or, to my knowledge, been exposed to COVID-19 within the past 45 days. Neither Camper nor anyone in Xxxxxx’s immediate family has experienced any of the following symptoms in the past seven days nor have they been on medication to alleviate any such symptoms in the past seven days: cough, sore throat, fever, shortness of breath, loss of smell and loss of taste. In the event Camper or anyone in Xxxxxx’s immediate family experiences any of the foregoing symptoms, I will notify the Club immediately and will not bring Camper back to the Club.
Health Statement. The proposed activity provided by the Angelina College Ropes Course, requires participation in physical exercises, which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart related or other diseases. Therefore, all participants must be free of medical or physical conditions, which might create undue risk to themselves or any others who depend on them. Good physical condition will increase your enjoyment of the outdoor activities. If there is any doubt about your ability to safely participate in the experience, you should have a physical examination. Participant Name: Male  Female  Age: Date of Birth: Street Address: City, State, Zip: Home Phone: Work Phone: Cell Phone: Staff signature: Participant signature: In an EMERGENCY, please notify (provide name & relation): Where will this person be during the time you will be on the course? (if at work, please provide name of business) Home/Cell Phone: Work Phone: Have you had or do you currently have any heart problems (dates)? YES NO Do you frequently suffer from pains in your chest? YES NO Do you often feel faint or have spells of severe dizziness? YES NO Has a doctor ever told you that you have high blood pressure? YES NO Are you a smoker?Do you have arthritis, joint or back problems that might be aggravated by exercise? Have you had any operations or serious injuries (dates)? Do you have any disabilities or chronic recurring illnesses or communicable diseases? YES YES YES YES NO NO NO NO Are there any activities to be limited/discouraged by physician's advice? YES NO Do you have Epilepsy? YES NO Do you have Diabetes? YES NO Are you allergic to any medicines, insects or pollen? (Circle all that apply & identify where necessary) YES NO Do you have asthma? If so, how often do you use an inhaler? YES NO Are you currently pregnant? If so, how many months? YES NO Are you currently sick and/or using a medication that's not listed above? YES NO Do you carry family medical/hospital insurance? YES NO Carrier: Policy #: Suggestions or health related information for the Angelina College Ropes Course: General Health Statement (check one): Excellent  Good  Fair  Poor  This health history is correct so far as I know and I believe that my health is satisfactory to participate in ropes course activities.
Health Statement. I understand that I am responsible for submitting a complete and accurate medical history on the forms provided by IPO or any follow-up forms required by IPO or my host institution, and I state that I have done so. I certify that I am free of medical conditions that would endanger my life, health, or well-being while traveling or living abroad, or that would impede my ability to fully participate in all aspects of the Program. I will follow my doctor’s advice on travel medicine, etc., and will follow the recommendations of the Centers for Disease Control (xxxx://xxx.xxx.xxx/travel/), provided that they do not conflict with my doctor’s advice, so that I will remain healthy on the program. I agree to take any medications, as prescribed, that are necessary to stay healthy, including medicines needed to manage mental illnesses or other chronic medical conditions. I also understand that if I do not make my medical or psychological needs known in a timely manner, IPO may delay my participation in the program until reasonable alternatives can be determined. I agree that if in the course of the program, the program director or the Director of Education Abroad determines in good faith judgment that the health, safety, welfare of myself or my fellow participants, or the integrity of the program experience, is jeopardized by my continued participation, I shall withdraw from the program and return to the United States, or be subject to expulsion. In such cases of medical withdrawal IPO will make every reasonable effort to ensure that I can receive partial credits or refund of program fees, where possible. I understand that I am responsible for requesting reasonable accommodations related to a disability in a reasonable time frame prior to departure. I understand that I must provide IPO and University of Massachusetts Disability Services with any documentation required in conjunction with my request for accommodations. I further understand that legal and cultural expectations are not the same overseas as they are in the United States, and that my requested accommodations may not always be available at all overseas sites or programs, but that IPO will make every effort to ensure such accommodations are available. I understand that for the duration of my program and specific to the official program dates, I will be covered by the UMass Out-of- Country Accident & Emergency Sickness Medical Coverage. I understand this coverage is only available outside the U.S. and does no...
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Health Statement. Neither Participant nor anyone in Participant’s household has tested positive for Covid-19 in the previous 10 days. Neither Participant nor anyone in Participant’s household has had close contact in the previous 14 days with someone who, within 48 hours before or 10 days after such contact, tested positive for Covid-19, suspected they had Covid-19 or showed symptoms of Covid-19. Symptoms of Covid-19 may include fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea. Neither Participant nor anyone in Participant’s household has experienced any of the foregoing symptoms in the previous 10 days. In the event Participant or anyone in Participant’s household experiences any of the foregoing symptoms or is exposed to Covid-19, Participant will not return to the Club until cleared to do so by a healthcare provider.
Health Statement a. I hereby certify that my child is in good health. If the child has any activity restrictions, please list b. I hereby certify that my child’s immunizations are up-to-date. c. I hereby certify that my child’s immunization record or appropriate waiver is on file with the child’s school.

Related to Health Statement

  • Problem Statement School bus fleets are aging, and our communities have poor air quality. Replacing school buses with zero emission school buses will address both of these issues.

  • False Statements Contractor represents and warrants that all statements and information prepared and submitted by Contractor in this Contract and any related Solicitation Response are current, complete, true, and accurate. Contractor acknowledges any false statement or material misrepresentation made by Contractor during the performance of this Contract or any related Solicitation is a material breach of contract and may void this Contract. Further, Contractor understands, acknowledges, and agrees that any false representation or any failure to comply with a representation, warranty, or certification made by Contractor is subject to all civil and criminal consequences provided at law or in equity including, but not limited to, immediate termination of this Contract.

  • Compliance Statement Within thirty (30) days after the last day of each month and together with the statements set forth in Section 5.3(c), a duly completed Compliance Statement, confirming that as of the end of such month, Borrower was in full compliance with all of the terms and conditions of this Agreement, and setting forth calculations showing compliance with the financial covenants set forth in this Agreement and such other information as Bank may reasonably request;

  • LEAD WARNING STATEMENT Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips and dust pose health hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978 housing, OWNERS must disclose the presence of known lead-based paint hazards in the dwelling. RESIDENTS must also receive a federally approved pamphlet on lead poisoning prevention.

  • CERTIFICATION REGARDING BOYCOTTING CERTAIN ENERGY COMPANIES (Texas law as of September 1, 2021) By submitting a proposal to this Solicitation, you certify that you agree, when it is applicable, to the following required by Texas law as of September 1, 2021: If (a) company is not a sole proprietorship; (b) company has ten (10) or more full-time employees; and (c) this contract has a value of $100,000 or more that is to be paid wholly or partly from public funds, the following certification shall apply; otherwise, this certification is not required. Pursuant to Tex. Gov’t Code Ch. 2274 of SB 13 (87th session), the company hereby certifies and verifies that the company, or any wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of these entities or business associations, if any, does not boycott energy companies and will not boycott energy companies during the term of the contract. For purposes of this contract, the term “company” shall mean an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, that exists to make a profit. The term “boycott energy company” shall mean “without an ordinary business purpose, refusing to deal with, terminating business activities with, or otherwise taking any action intended to penalize, inflict economic harm on, or limit commercial relations with a company because the company (a) engages in the exploration, production, utilization, transportation, sale, or manufacturing of fossil fuel-based energy and does not commit or pledge to meet environmental standards beyond applicable federal and state law, or (b) does business with a company described by paragraph (a).” See Tex. Gov’t Code § 809.001(1).

  • Earning Statement The Company will make generally available to its security holders and the Representatives as soon as practicable an earning statement that satisfies the provisions of Section 11(a) of the Securities Act and Rule 158 of the Commission promulgated thereunder covering a period of at least twelve months beginning with the first fiscal quarter of the Company occurring after the “effective date” (as defined in Rule 158) of the Registration Statement.

  • Certified and Minority Business Enterprises Reports Upon Customer request, the Contractor shall report to the requesting Customer the Contractor’s spend with certified and other minority business enterprises in the provision of commodities or services related to the Customer’s orders. These reports shall include the period covered, the name, minority code, and Federal Employer Identification Number of each minority business utilized during the period; commodities and services provided by the minority business enterprise, and the amount paid to each minority business enterprise on behalf of the Customer.

  • CERTIFICATION REGARDING BOYCOTTING CERTAIN ENERGY COMPANIES (Texas law as of September 1, 2021) By submitting a proposal to this Solicitation, you certify that you agree, when it is applicable, to the following required by Texas law as of September 1, 2021: If (a) company is not a sole proprietorship; (b) company has ten (10) or more full-time employees; and (c) this contract has a value of $100,000 or more that is to be paid wholly or partly from public funds, the following certification shall apply; otherwise, this certification is not required. Pursuant to Tex. Gov’t Code Ch. 2274 of SB 13 (87th session), the company hereby certifies and verifies that the company, or any wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of these entities or business associations, if any, does not boycott energy companies and will not boycott energy companies during the term of the contract. For purposes of this contract, the term “company” shall mean an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, that exists to make a profit. The term “boycott energy company” shall mean “without an ordinary business purpose, refusing to deal with, terminating business activities with, or otherwise taking any action intended to penalize, inflict economic harm on, or limit commercial relations with a company because the company (a) engages in the exploration, production, utilization, transportation, sale, or manufacturing of fossil fuel-based energy and does not commit or pledge to meet environmental standards beyond applicable federal and state law, or (b) does business with a company described by paragraph (a).” See Tex. Gov’t Code § 809.001(1).

  • Operating Statements In the case of each Mortgage Loan, the related Mortgage or another Mortgage Loan document requires the related Mortgagor, in some cases at the request of the lender, to provide the holder of such Mortgage Loan with at least quarterly operating statements and rent rolls (if there is more than one tenant) for the related Mortgaged Property and annual financial statements of the related Mortgagor, and with such other information as may be required therein.

  • Production Report and Lease Operating Statements Within 60 days after the end of each fiscal quarter, a report setting forth, for each calendar month during the then current fiscal year to date, the volume of production and sales attributable to production (and the prices at which such sales were made and the revenues derived from such sales) for each such calendar month from the Oil and Gas Properties, and setting forth the related ad valorem, severance and production taxes and lease operating expenses attributable thereto and incurred for each such calendar month.

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