2019 Florida Youth Camp
Orlando Church of Christ
Photo Consent and Release Form

I have been advised that a photography crew will be present at the 2019 Florida Youth Camp sponsored by the Orlando Church of Christ to photograph, videotape, film, and/or otherwise record participants (which includes all social media). I acknowledge and irrevocably consent a) to such photography, videotaping, filming and/or recordings of my child, and (b) that the 2019 Florida Youth Camp and its affiliates may publish, print, display such images, recordings, portrait, photographs, sensory image or other likeness. I waive and release any right to compensation, including but not limited to royalties or license fees, as well as any right of inspection or approval of any such media. I release the 2019 Florida Youth Camp sponsored by the Orlando Church of Christ and any of its affiliated Churches and any employees, agents, representatives, contractors and subcontractors from any liability for any claim of alteration, optical allusion, faulty mechanical reproduction, art work or retouching.

This Consent and Release Form shall be construed and interpreted in accordance with the laws of the State of Florida, excluding those dealing with conflicts of laws.

2019 Florida Youth Camp
Orlando Church of Christ
Notice of Privacy Practices/HIPAA (7/06)

This Notice describes how health information about you may be used and disclosed. It applies to all protected health information contained in your health records maintained by us. We have the following duties regarding the maintenance, use and disclosure of your health records:
We are required by law to maintain the privacy of the protected health information in your records and to provide you with this Notice of our legal duties and privacy practices with respect to that information.
We are required to abide by the terms of this Notice currently in effect.
We reserve the right to change the terms of this Notice at any time, making the new provisions effective for all health information and records that we have and continue to maintain. All changes in this Notice will be prominently displayed and available at our office.

There are a number of situations in which we may use or disclose to other persons or entities your confidential health information. Certain uses and disclosures will require you to sign an acknowledgement that you received this Notice of Privacy Practices. These include treatment. Any use or disclosure of your protected health information required for anything other than treatment requires you to sign an Authorization. Certain disclosures that are required by law, or under emergency circumstances, may be made without your Acknowledgement or Authorization. Under any circumstance, we will use or disclose only the minimum amount of information necessary from your medical records to accomplish the intended purpose of the disclosure. We will attempt in good faith to obtain our signed Acknowledgement that you received this Notice to use and disclose your confidential medical information for the following purposes. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office once you have provided Consent.

Others involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your child’s protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your child’s care, of their location and general condition.

Communication Barriers and Emergencies: We may use and disclose your protected health information if we attempt to obtain consent from you but are unable to do so because of substantial communication barriers and we determine, using professional judgment, that you intend to consent to use or disclosure under the circumstances. We may use or disclose your child’s protected health information in an emergency procedure/treatment situation. If this happens, we will try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If we are required by law or as a matter of necessity to treat your child, and we have attempted to obtain your consent but have been unable to obtain your consent, we may still use or disclose your protected health information to treat your child. Except as indicated above, your health information will not be used or disclosed to any other person or entity without your specific Authorization, which may be revoked at any time. In particular, except to the extent disclosure has been made to governmental entities required by law to maintain the confidentiality of the information, information will not be further disclosed to any other person or entity with respect to information concerning mental-health treatment, drug and alcohol abuse, HIV/AIDS or sexually transmitted diseases that may be contained in your health records. We likewise will not disclose your health-record information to an employer for purposes of making employment decisions, to a liability insurer or attorney as a result of injuries sustained in an automobile accident, or to educational authorities, without your written authorization.