2016 Medical Information and Photo Release Form

Please be sure to fill this form out in its entirety.

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If primary contact is not available, in an emergency notify:

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If you are taking any medications please list them below

If you are not covered by medical insurance please contact ABW for an insurance waiver

Should the student named herein require medical treatment or hospitalization for any accident or illness during Alaska Business Week, the attending physician and/or hospital is authorized to release such diagnostic and treatment information as may be needed to complete any insurance claim. It is agreed that any and all medical expenses incurred by the student for accidents or illnesses occurring during Alaska Business Week are not the responsibility of Alaska Business Week or the host university.

In addition, this is to certify that I, the undersigned parent/guardian, hereby consent to and authorize the administration and performance of all needed medicines (and surgical treatment) and the administration of any anesthetic which in the opinion of the attending physician may be necessary and advisable in the event of any medical emergencies regarding the named students. As the undersigned parent/guardian, I hereby authorize the administration of over-the-counter medications (i.e. aspirin, tylenol, antacids, ibuprofen, cough drops, etc.) by Alaska Business Week staff to the student named herein.

I, the parent/guardian of the above named student do hereby agree to release and hold harmless Alaska Business Week, the Alaska State Chamber of Commerce (D.B.A. Alaska Chamber), and their partners Alaska Pacific University and the Foundation for Private Enterprise Education D.B.A.. Washington Business Week, against any and all actions, claims, costs, losses, expenses and/or damages, including attorney's fees, arising out of or resulting from my child's attendance at the Alaska Business Week program, except due to a party's sole gross negligence or willful misconduct.


The undersigned hereby releases any photos, videos, or likenesses of the participant named in this form taken by Alaska Business Week, to be used for promotional and publication materials. Alaska Business Week does not attach names to photos without permission.


We cannot admit any student to Alaska Business Week without this completed form with correct information. Our insurance carrier and our program require we have this information. We must ensure proper medical treatment can be made available to all participating students in case of emergencies. Thank you.