SAGES 2019 Mini Medical School Boot Camp Application & Permission FormSAGES 2019 Mini Medical School Boot Camp Application & Permission Form Saturday, April 6, 2019; 7:30am – 2pm Baltimore Convention Center, Baltimore, MD Guidelines: Parents are responsible to transport their children to the program and back home. Children must be dropped off and sign in by 8am, and be picked up at 2pm, at the Baltimore Convention Center, Baltimore, MD - SAGES Meeting. Lunch will be served. There is no charge for the students to attend the program. Upon completion, each student will receive a certificate of participation as well as the possibility of winning special recognition awards. Final application deadline is February 15, 2019!School Teacher/ Counselor to fill out:School/Student InformationSchool Name:*Student Name:* First Last Current Grade*12th11th10th9th8thCurrent GPA*Please enter a value between 1.0 and 5.0.Teacher/Counselor Name* First Last Teacher/Counselor PhoneIf knownParent/Guardian/Emergency Contact InformationEmergency Contact Name* First Last Emergency Contact Phone*Parent/Guardian Name* First Last Parent/Guardian Phone:*I give permission for my child to attend the Mini Medical School Boot Camp*Saturday, April 6, 2019 from 7:30am to 2pm. I agree.Parent/Guardian Email Address (for confirmation/acceptance):* Photo and Video Release Form - Permission to Use Photograph and Video Recording*I grant to SAGES, the right to take video and/or photographs of my child (name specified above) in connection with this event. I authorize SAGES, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that SAGES may use such videos and/or photographs of the participants with or without their name identification and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read, understand and agree to the above.Emergency Treatment Consent*In case of an emergency, I give permission for my child to receive medical treatment deemed necessary and appropriate by any physician present, and I accept responsibility for any cost incurred for such treatment. I have read, understand and agree to the abovePhoneThis field is for validation purposes and should be left unchanged.