Common use of Participant Name Clause in Contracts

Participant Name. First MI Last Participant Phone: ( ) - ( ) - 🞎 Home 🞎 Cell Work Personal Physician: ( ) - Name Phone In case of emergency, please contact: ( ) - Name Phone Participant Age: Special Dietary Considerations: List required medications: List known allergies: If allergic to bee / insect stings, do you have an Epi-Pen with you? Do you wear contact lenses? Are you pregnant? Are you afraid of Heights or Edges? Have you had or do you now have (Check ALL that apply below): 🞎 Heart Disease 🞎 Diabetes 🞎 Asthma 🞎 Nerve/Muscle Problem 🞎 Epilepsy 🞎 Chest pains 🞎 Drug reactions 🞎 High blood pressure 🞎 Bone/Joint Problem If you checked ANY of the above, EXPLAIN below & include date(s): Do you have any other medical conditions that might interfere WITH YOUR ABILITY TO PARTICIPATE IN STRENUOUS PHYSICAL ACTIVITY OFCLIMBING OR RAPPELLING OR TO FOLLOW DIRECTIONS? Do you have a current BSA Annual Health and Medical Record including the signed Part C authorizing treatment in the event of emergency on file with your Unit? Unit # Has your son earned the Climbing Merit Badge? / / Signature of Participant Date / /

Participant Name. First MI Last Participant Phone: ( ) - ( ) - 🞎 Home 🞎 Cell Work Personal Physician: ( ) - Name Phone In case of emergency, please contact: ( ) - Name Phone Participant Age: Special Dietary Considerations: List required medications: List known allergies: If allergic to bee / insect stings, do you have an Epi-Pen with you0 ? Do you wear contact lenses0 ? Are you pregnant0 ? Are you afraid of Heights or Edges0 ? Have you had or do you now have (Check ALL that apply below): 🞎 Heart Disease 🞎 Diabetes 🞎 Asthma 🞎 Nerve/Muscle Problem 🞎 Epilepsy 🞎 Chest pains 🞎 Drug reactions 🞎 High blood pressure 🞎 Bone/Joint Problem If you checked ANY of the above, EXPLAIN below & include date(s): Do you have any other medical conditions that might interfere WITH YOUR ABILITY TO PARTICIPATE IN STRENUOUS PHYSICAL ACTIVITY OFCLIMBING OR RAPPELLING OR TO FOLLOW D0 IRECTIONS? Do you have a current BSA Annual Health and Medical Record including the signed Part C authorizing treatment in the event of emergency on file with 0 your Unit? Unit # Has your son earned the Climbing Me0 rit Badge? / / Signature of Participa/ Signature of Parent or Guardian Datent Date / /