Intercollegiate Athletics Policy Manual

4.00 Camp Policy Manual

APPENDIX - Medical 15.30.11 Acknowledgement of Receipt - Minor

THE UNIVERSITY OF TEXAS AT AUSTIN
University Sponsored Summer Sports Camps

ACKNOWLEDGEMENT OF RECEIPT
OF THE "NOTICE OF PRIVACY PRACTICES"

 

I  acknowledge that I have received
(print parent/guardian’s name)

a copy of the "Notice of Privacy Practices" of The University of Texas at Austin.

Date:

Signed:  
  (parent or guardian)

Camper’s Name:
  (please print)

Camper’s DOB:  Camp: 

 

last updated: February 11, 2009