Participant Details, Waiver & Consent form
Medications
Will the Applicant be taking any medications while at From Scratch Farm Supports?
Please explain the reason for the medication, any reactions to be watching for, and any notes on giving this medication to the Applicant if they are not self administering.
May the following over-the-counter medications be given to the Applicant while at FSFS on an "as needed basis"?
Please list all other medications that the applicant is taking (in case of emergency trip)
Participant Agreements and Waivers
Please read and sign below:
PRIVACY NOTICE
By signing below you are acknowledging our Privacy Policy , if you have questions or concerns about how your/the participant data is used at From Scratch Farm, please contact us at AskUs@FromScratchFarm.ca.
I hereby give permission for photos to be taken of the participant for inclusion in social media posts and advertising publications.
ROUTINE AND EMERGENCY PICK-UP
By signing below, I acknowledge that only authorized individuals pick up the Participant and that these individuals are available to pick up the Participant both at the end of program or during programs in the event of an emergency or for other reasons. I acknowledge that I must ensure that all emergency contacts are aware of this responsibility prior to the Participant’s arrival at the Farm.
All authorized people understand that they may be called upon to pick up the Participant either at the end of their workshop/activity or during the session, in case the primary caregiver is not available. I know.. it's redundant, but we want to be sure someone is available.
INJURY/ILLNESS
By signing below, I acknowledge that From Scratch Farm is not responsible for any illness or accidental harm that might occur to the Applicant. The term illness includes but is not limited to any infectious diseases or other illnesses that might occur in the community. Accidental harm includes but is not limited to harm arising from any event that was not intentionally or willfully caused by any member of From Scratch Farm staff or volunteer. For example, if the Participant was to be injured as a result of a trip and fall incident, if they were to be hit in the course of play, or if they were injured by another participant, etc.
DISCLOSURE
By signing below, I acknowledge that I understand that failure to include any information about properly caring for the Applicant in this application or in writing prior to the Applicant’s participation in sessions will result in the Applicant being removed from the program and asked to leave the session. I have disclosed all the information above to any individual that may be involved in the application process, pick-up/drop-off, or communication with From Scratch Farm regarding the applicant for the 2022 season.
APPLICATION CONSIDERATION
By signing below, I acknowledge that I understand that From Scratch Farm reserves the right to deny an application for any reason. Common reasons for denying an application: behavioural needs are too great for staff to manage, participant cannot self-transfer to toilet, or medical needs are too great for staff to manage.
For the safety of those participating, individuals with behavioural challenges who pose a risk of danger to themselves or others, and who require a Behavioural Support Plan and facilitator, are not able to participate in our programming. It is our hope in the future to offer some programming that could be more inclusive.
When you click submit you also accept and understand why we are collecting and how we use the information, details are available in our Privacy Policy
Oops! Looks like you may have missed a box please scroll up and look for the red box/star to complete form, then re-submit
You did it!!!!