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D I S C O V E R A N D P L A Y

19

2016-2017 Registration

(cont.)

Health and Medical Information

MEDICATION INFORMATION

Only medications that are medically necessary and cannot be scheduled outside the hours of the recreation program

will be given during the program. No program participant should be in possession of nonprescription or prescription

medication of ANY kind without the knowledge of the program staff. Any participant who must receive medication during

the program must have on file the appropriate signed medication form:

Assisted Administration of Medication: Parks, Recreation, and Cultural Resources staff maintains, provides and monitors

consumption of both prescription and nonprescription medication.

Self-Administration of Medication (for use in Teen, Adventure and SRS Adult Programs ONLY): Participant may maintain and

consume nonprescription medication, inhalers and/or EpiPen as needed with review from staff.

The Assisted Administration of Medication form is included within this brochure. Both forms may also be obtained by

contacting the specific program location or by calling the Recreation Business Office at 919-996-4800. Medication forms

should be submitted PRIOR to participation.

Please list any medication the participant will be taking during this program and additional information you would like to

share:

______________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

By signing below, I acknowledge the following:

The City of Raleigh provides no insurance coverage for participants;

I have read, understand and agree to the City of Raleigh Parks, Recreation, and Cultural Resources School Based

Program Policies on pages 23-26.

I understand I am waiving my legal rights. (Please refer to program policies)

In the event of a medical emergency, every effort will be made to contact parent(s)/ guardian(s).

I authorize the City of Raleigh staff to seek appropriate medical care if a parent/guardian cannot be reached.

I have selected an appropriate program for the interests and abilities of the participant, and the information I have

provided on the Participant Information Form is current and accurate.

Signature is required to complete the registration process. Any person listed as the parent or

guardian on the registration form may add or remove a pick-up person.

Staff will release information about the participant only to those person(s) listed.

Participant Name____________________________________ Parent/Guardian Signature____________________________________

Participant Name____________________________________ Parent/Guardian Signature____________________________________

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