Fillable Volunteer Job Shadow Parent Consent And Release Of Liability Form printable pdf download

Volunteer Job Shadow Parent Consent And Release Of Liability Form

Download a blank fillable Volunteer Job Shadow Parent Consent And Release Of Liability Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Volunteer Job Shadow Parent Consent And Release Of Liability Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Volunteer/Job Shadow Parent Consent and Release of Liability Form

If volunteer/shadower is under of the age of 18, parental guardian consent is required.

My son/daughter, _______________________, has my permission to serve as a KentuckyOne Teen

Volunteer and/or participate in the KentuckyOne Health Job Shadow experience. As the

parent/guardian of the above-named student, I will read the literature that is provided to my child so

that I know what will be expected of him/her.

I attest that my child is at least 14 years of age (Volunteer Program) or 16 years of age (Job

Shadower Program) and is free from communicable diseases and will be able to provide evidence of

negative TB screening and proof of immunization (signed by licensed nurse or healthcare provider),

immunity by laboratory results (positive titre), or natural disease history (diagnosed, documented, and

signed by licensed healthcare provider) of rubella (German measles), rubeola (measles), and

varicella (chicken pox) within 24 hours of request by hospital personnel.

Volunteering and/or Job Shadowing may include observing patients in a healthcare setting and

observing medical, laboratory, and/or business procedures. I further understand that KentuckyOne

Health offers medical services for the care and treatment of a wide range of illnesses, diseases and

injuries, including but not limited to, such infectious diseases as tuberculosis, hepatitis, and HIV and

that there is a risk, however slight, that my son/daughter might be inadvertently exposed to such

diseases at the Hospital.

I do hereby release KentuckyOne Health, their staff and sponsors from any responsibilities of injury or

accident as a result of the volunteering/shadowing experience. Any medical expenses incurred as a

result of injury or accident will be my responsibility.

I understand that in case of a medical emergency, every attempt will be made to contact me before

medical action is taken. However, this document is my consent as parent or guardian for emergency

treatment and/or procedures necessary for my son/daughter by the professional staff at KentuckyOne

Health.

I release, discharge and relieve KentuckyOne Health from any and all claims whatsoever of any

nature as a result of his/her volunteering/shadowing and all related activities.

___________________________________________________ Date_________________________

Parent/Guardian Signature

Volunteer Job Shadow Parent Consent And Release Of Liability Form

Related Articles

Related forms

Related Categories