Statewide Camp Beyond the Deaf Home

I give permission for my student to participate in Pre‑Employment camp activities that may include, but are not limited to: Participate in Job Exploration Activities; Take part in community work experiences; Explore post-secondary training options; Learn habits, attitudes, and behaviors for work; Learn about their strengths, abilities, & capabilities; Identify skills and goals for work and adult living; Take field trips; Staying in a shared room/staffed dormitory.

I hereby attest that I understand and assume the risk of my student participating in an away overnight camp, and agree to my child attending and participating in all activities, unless listed below.

I give VR permission to release and allow electronic access to all records about my child to VR, including but not limited to: Career exploration information, School grades and progress reports, Summer Pre‑Employment Program Contractors, Individual Education Program (IEP), School Multidisciplinary Team Report, Work experience info and records, 504 Accommodation Plan, Psychological Evaluations & Reports, Functional Behavioral Assessment, Safety Plan, Behavioral Intervention Plan, School records.

Nevada VR will not re-release the education records it receives without my written consent unless it is required by law. I may end this consent at any time by providing VR a signed and dated statement to that effect. In any event, consent will end one year from the date my child no longer receives VR services. I hereby attest that my responses and the information provided on this form is complete and accurate. I give my consent for Nevada VR to exchange information with school staff, mentors, Educational Services, Post-secondary Institutions, Assistive Technology Partners, team for the Blind & Visually Impaired, NV Developmental Disabilities, NV Department of Labor, Social Security Admin, and Employers (past, current or prospective). In addition, VR can exchange information with the following the following persons, programs, or agencies serving my child: (see program agenda for list)

I am the parent/legal guardian of the youth named above (hereinafter referred to as "Child"), who is under my care and responsibility.

I hereby consent and give authority to the participation of my Child in the scheduled youth activities of the Camp, and all other activities which is supervised and customarily associated with its youth group.

I hereby declare and affirm that my Child is physically fit to take part in the Camp's activities and my Child has no known illness or adverse medical condition that would render him/her unfit to participate therein, other than the information specified in the medical information above.

I shall immediately advise the organizers in writing, should I discover any illness, adverse medical condition, or any other physical defect that would render my Child unfit to participate in the recreational and sporting activities of the Camp.

I shall notify the organizers immediately in case I revoke my consent to the Camp for this event.

I understand that in case of medical emergencies involving my Child, I shall be notified right away. In case any of my provided contact information is unreachable, I authorize the organization to call the emergency contact indicated above. In case that the emergency contact is unavailable, I authorize the organizers to call any doctor or emergency service to provide the necessary medical attention to my child.

I understand that the camp shall not be responsible, and shall be reimbursed, for any medical expenses incurred by them over this authorization.

By agreeing to this Electronic Signature Consent, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I understand that my electronic signature is legally binding. By signing below, I accept the conditions of this agreement.