Intercollegiate Athletics Policy Manual

4.00 Camp Policy Manual

APPENDIX - Medical 15.30.12 Acknowledgement of Receipt - Adult

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 name)

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

Date:  

Signed:  

Camper’s DOB:  Camp: 

 

last updated: February 11, 2009