Scrubs Camp Release

Liability and Photo Waiver

Your signature below authorizes the South Dakota Department of Education (SD DOE) and the South Dakota Department of Health (SD DOH) to be referenced periodically to evaluate the Scrubs Camps. Students participating in the Scrubs Camps may be contacted in the future for evaluation purposes.

In consideration of the student’s acceptance into and participation in the Scrubs Camp, any and all claims that the student and/or the student’s parents, guardians, heirs, agents, representatives, successors or assigns might have against the South Dakota Department of Education and/or South Dakota Department of Health, its employees, contractors, grantees, sponsors, officials and volunteers, for any and all injury or illness which may directly or indirectly result from the student’s participation in this program are waived by signing below.

By signing below, the facilitators of the Scrubs Camps are granted the non-exclusive and irrevocable rights and license to make, edit, and use pictures for publicity, news or advertising; including print, video, broadcast media and the internet. The facilitators of the Scrubs Camps are released from any and all claims of payment for performance rights, residuals or damages for libel, slander, invasion of privacy, or any claim based on the use of said material.

Parental Guardian Notification

Due to the nature of this camp, students may be exposed to latex, finger stick blood sampling, and other elements of a basic physical exam. By signing below, the student’s parent/guardian acknowledges and accepts these possible risks.

Acknowledge and Accept:
By entering your name, you are agreeing to the above information.