Consult and Update of the Enrollment Medical Form

LOS ANDES UNIVERSITY SPORTS CENTER

Consult and Update of the Enrollment Medical Form

INFORMED CONSENT

I,______holder of Identity Card No. ______,from the city of ______,acting as USER AND/ORGUARDIANof the minor ______identified with Identity Card No. ______, from the city of ______,hereby commit to following the recommendations given by the support team, as well as these observations:

1. That the information submitted in the Enrollment Medical Form (via the website or in person) is correct and that all omissions on behalf of the user may constitute an attempt against their own personal integrity, exonerating the Los Andes University from any and all responsibility upon signature of this document, and that if there is proof of inadequate behavior upon its delivery, the University is hereby authorized to withdraw the benefits to enjoy the right hereby granted.

2. That enough information has been received on the benefits and the nature of the procedures, as well as of the risks caused by non-compliance with the recommendations of the interdisciplinary team (doctor, instructors, teachers and trainers).

3. That the doctor and the interdisciplinary team comprising the instructors, teachers and trainers, after evaluating the Enrollment Medical Form and/or performing a medical consult, without any warning of any background that would make practicing sports, physical activities or exercise unadvisable, states that the authorized practices are the most appropriate within the possible alternatives in compliance with the conditions for the user.

4. To give informed consent for the practice, if necessary and consensually agreed upon, of medical procedures, invasive or not, related with the assessment and follow up of the user’s health for the medical prescription of sports programs, physical activity and exercise, as per the orders of a Medical Doctor specialized in Sports Medicine.

5. To give informed consent for the practice, if necessary and consensually agreed upon, of medical procedures, invasive or not, related with the treatment of medical urgencies or emergencies as per the orders of a Medical Doctor specialized in Sports Medicine.

6. That all inquiries were satisfactorily answered, thus freeing the Los Andes University of any and all responsibility for consequences of negligence, imprudence, inexperience, disregard or omissions on behalf of the user regarding the recommendations made by the consulting team, as well as of consequences inherent to accidents.

TheLos Andes University is committed with the proper, legal and safe use of your personal information. Please consult our Information Treatment Policy.

Signature ______

Date ______