Forms

• Waiver Indemnification and Medical Authorization - a liability waiver that the participant/parent/legal guardian signs accepting any associated risk of the activity involved and further agrees to release, waive, not to sue, and agree to hold harmless for any and all purposes associated with participation.
  • The (“Activity”) space is the name of your program.
  • The (“Sponsor”) space is the name of your organization/department.

All programs must obtain authorization for administering any prescription, or over-the-counter medication from the participant’s parent/guardian prior to enrollment in the program. The participant’s parent/guardian may not authorize administering medication in excess of the medication’s label instructions or the directions of the participant’s healthcare professional.

• Permission for Self-Medication Form - written permission from parent/guardian for their child of 15 years of age and older, is responsible for administering their own medication under the condition that the participant can self-manage care and will be the only one who receives the medication.
• Parent/Guardian Authorization, and Consent for Over-the-Counter Medication Form – allows parents to provide written permission for the administration of over-the-counter medications during the participant's stay.

Note: Parent/guardian authorization is NOT required for administering a medication to a participant in a medical emergency to prevent the death or serious bodily injury of the participant, provided that the medication is administered as prescribed, directed, or intended.

Hazard Risk Matrix – this risk assessment and mitigation form is required for all CPMs in collaboration with the Office of Risk Management. If you have questions, please contact Richard Smith via email at rcsmith@wtamu.edu.

Texas Department of Safety and Health Sciences (TDSHS) Form – this form is required only for CPMs that will host an overnight program or a daytime program of < 4 consecutive days and < 20 campers.

• All Campus Programs for Minors must submit the TDSHS Form no later than three (3) business days before the first day of camp by email to Programsforminors@wtamu.edu
• After this is reviewed it will be submitted to TDSHS by email PHSCPS@dshs.state.tx.us.
• This document provides a summary of the staff members for your program who have completed child protection training.
• Once this form is completed the Extended Studies office will submit this to the State of Texas on your behalf.

Authorization for Dispensing Medication Log Form – the Camp Program for Minors (CPM) staff must record the full name of the participant, the name of the medication, the date and time the medication was given, and full name of the staff/volunteer that administered medication.

For further specific instructions for administering medication, please refer to the Campus Programs for Minors University Rule.