CONSENT FORMConsent Form • November 2nd, 2018
Exhibit 10.84 Translated from Japanese CONSENT FORM SoftBank Telecom ("SBTM" hereinafter), Global Hotline ("GHI" hereinafter) and SG Telecom ("SG" hereinafter) are to agree as follows in SG's promoting the business activity of securing customers for...Consent Form • September 3rd, 2009 • Ia Global Inc • Communications services, nec
Patient agreement to:Consent Form • August 10th, 2023
(To be filled in by health professional with appropriate knowledge of proposed procedure, as specified in consent policy)
Addressograph Patient’s surname / family name: Patient’s first name(s):Consent Form • September 4th, 2020
‘CONFIDENTIAL – once completed this form must be kept securely all the time’ Family Support Service CONSENT FORM AND INFORMATION FOR FAMILIESConsent Form • June 13th, 2018
Client/patient/parental agreement to video/audio recordingConsent Form • April 20th, 2021
Statement of health professional (to be filled in by health professional with appropriate knowledge of proposed aspect of treatment, as specified in consent policy)
ContractConsent Form • September 21st, 2007
To make sure that you agree that we can archive your interviews, we ask you to sign a consent form that says that we can do this. We will also sign the form, and we will give you a copy to keep.
Kelly Roche HouseConsent Form • March 11th, 2014
Consent FormConsent Form • September 25th, 2023
Visits, trips or excursions off First School’s premises will be offered to our students from time to time mostly in the form of nature walks or walks to a near by park.
CONSENT FORMConsent Form • June 26th, 2024
Consent to our infrared light therapy treatment is conditional upon providing accurate answers to the following questions and signing this agreement. If you have any health concerns, we highly recommend you consult a doctor prior to use.
Parental (or person with parental responsibility) agreement to investigation or treatment for a child or young personConsent Form • February 12th, 2022
Agreement to Participate in ResearchConsent Form • April 26th, 2011
• The signature of a researcher on this document indicates agreement to include the above named subject in the research and attestation that the subject has been fully informed of his or her rights.
Agreement to take part in the Shared Medical Appointments Pilot ProjectConsent Form • August 7th, 2019
Your doctor has explained what shared medical appointments are and how they will work at Ernesettle Medical Centre. He has suggested that you may benefit from taking part and has invited you to join the 12 month pilot project.
Kelly Roche HouseConsent Form • October 7th, 2021
A consent form from the American Academy of Pain MedicineConsent Form • February 27th, 2019
The purpose of this agreement is to protect your access to controlled substances and to protect our ability to prescribe for you.
Company Name)Consent Form • December 3rd, 2022
Centricity, LLC recently joined forces with SemiosBio Technologies Inc (“Semios”). As you may be aware, Your Centricity Customer Data (as that term is defined in the “Agreement”) may only be shared with Semios with Your consent, as per the Centricity master services agreement published May 30th, 2019 (the “Agreement”).
COPE Climbing & Zipline Consent FormConsent Form • May 10th, 2021
Please read this agreement CAREFULLY before signing. If the participant is a minor (under the age of 18), all documents must also be signed by either a parent or legal guardian. All references to “participant” are deemed to include the parent or legal guardian of any participant who is a minor.
Agreement to ConsentConsent Form • July 3rd, 2018
The research project and procedures associated with it have been fully explained to me. I have read the information letter and have had time to consider whether to take part in this study. I have had the opportunity to ask questions concerning any and all aspects of the project and any procedures involved. I am aware that participation is voluntary. I am aware that my decision not to participate or withdraw will not restrict my access to Enable Ireland services normally available to me. Confidentially of records concerning my involvement in this project will be maintained in an appropriate manner. I agree that the data can be used in the publication of higher degrees, presentations and academic publications.
Consent FormConsent Form • February 7th, 2023
The Parent/Legal Guardian Agreement and consent for Medical Treatment Agreement must be completed and signed before a player can participate in the Jags Summer Training Program.
ContractConsent Form • April 13th, 2022
Do I need to sign the consent form? We believe you do. Building this education system the Anishinaabe way requires accurate and available data that will ensure student success and well-being are a continual focus. Most Anishinabek students will attend Ontario schools at one point or another. The KEB requires access to Ontario's data in order to track and help AES students in the Ontario system. Also, for planning and resourcing, Ontario needs to know which students are transitioning to and from their schools. Who founded this agreement? This agreement is between KEB and the Ministry of Education. The 23 Participating First Nations signed to be participants of the Anishinabek Education System, which is supported centrally by the KEB. Under the direction of the Participating First Nations, the KEB is helping to implement the education system and support improved relationships between Participating First Nations and Ontario District School Boards. The agreement was signed and has been in
Your Consent & AgreementConsent Form • March 12th, 2022
Your clinician has discussed alinio clear aligners with you. This treatment can be very beneficial, leading to a more attractive smile and healthier, straighter teeth and. However, you should be aware that it also has its limitations and potential risks.
Agreement of AuthorizationConsent Form • April 27th, 2016
PARTICIPANT AGREEMENT, ACKNOWLEDGEMENT OF RISK AND INJURY WAIVER FORMConsent Form • September 9th, 2020
FULL NAME DATE OF BIRTH GENDER ADDRESS POST CODE OWN PHONE NUMBER (IF OVER 18) EMAIL ADDRESS MEDICAL CONDITIONS EMERGENCY CONTACT NAME EMERGENCY CONTACT NUMBER HOW DID YOU HEAR ABOUT US?
Consent Form Food Handlers - Agreement on Disclosure of Illness to Food Business Operator (in accordance with the Data Protection Act 1998)Consent Form • November 26th, 2020
Agreement of person with parental responsibilityConsent Form • April 15th, 2013
This form should be used to document consent to a child’s examination or treatment, where that consent is being given by a person with parental responsibility for the child. Where children are Gillick competent to consent for themselves (see below), use the standard ‘adult’ consent form (Form 1). There is space on
Agreement To TreatmentConsent Form • February 2nd, 2021
This section is completed with you by the anaesthetist usually on the day of surgery Proposed anaesthesia: General � Local � Regional � Spinal/epidural � Sedation � (Please tick)Other: Risk discussionSore throat � Nausea/vomiting � Dental damage � Allergic reaction � Itch � Blood clots �Block failure � Nerve damage � Headache � Hypotension � Rare serious events � Pain � Bleeding � All of the above discussed � Pain relief planOral � Intravenous � PCA � Epidural � Spinal � Wound catheter � PR � Other �Discussion notes:
This agreement form represents written consent for my child to undertake the following activities under theConsent Form • February 15th, 2023
Any other matters that may impact your child’s participation in the above activities safely? Yes No If Yes, please outline details to the school in the box below:
Sample Consent FormConsent Form • January 17th, 2019
PLEASE NOTE: For research involving more than minimal risk, an explanation as to whether any compensation and an explanation as to whether any medical treatments are available if injury occurs and, if so, what they consist of, or where further information may be obtained.
Forsyth Academy of Performing Arts Agreement Form—REQUIRED!Consent Form • November 19th, 2020
Kelly Roche HouseConsent Form • March 19th, 2015
CAMP MIRI PIRI CONSENT FORMConsent Form • December 9th, 2010
Have read all the information on the Camp Miri Piri Sydney website and give consent for my child to participate in Camp Miri Piri Sydney at Wombaroo Adventure Centre from 15 April 2011 to 18 April 2011.
Between You & J. Gill Health ServicesConsent Form • April 19th, 2022
INFORMED CONSENT FOR BOTULINUM TOXIN & DERMAL FILLER INJECTIONS BETWEEN THE VOLUNTEER (YOU) & AESTHETIC MEDICAL EDUCATORS TRAINING, INC. (AMET)
DIAMAS Project consent formConsent Form • August 2nd, 2023
By signing this Agreement, the Interviewee explicitly consents to the collection and processing of their personal data (limited to names, contact information, and job titles) for the specified purpose mentioned in the first paragraph. The Interviewee acknowledges their consent has been freely given and understands they have the right to withdraw their consent at any time without affecting the lawfulness of processing based on consent before its withdrawal.
CONSENT FORMConsent Form • September 3rd, 2022
Consentee: [CONSENTEE'S NAME] with a mailing address of [MAILING ADDRESS] (“Consentee”) hereby consents and gives permission to:
RING OF BEARA CYCLE KENMARE CONSENT FORM SATURDAY 23RD MAY @ 10.00AM KENMAREConsent Form • May 13th, 2015
