Community Health and Wellness Medical Camp Participant Consent Form I, the undersigned, hereby consent to participate in the free health screening program offered by SSCC. I understand that this program is designed to provide health screenings and related services without charge. I voluntarily choose to participate in this program and acknowledge the following: Confidentiality: I understand that my health information will be kept confidential. I authorize the healthcare providers and staff involved in the screening program to collect, use, and disclose my health information for the purpose of treatment, including healthcare services, coordination of care, and follow-up if necessary. Follow-up Care: I understand that if the screening results indicate a potential health issue, I am encouraged to seek follow-up care with a qualified healthcare provider. I am aware that the screening program may provide information and resources for accessing appropriate healthcare services. Photography and Publicity: I grant permission to SSCC to use photographs, video recordings, or testimonials taken during the screening for promotional and educational purposes. I understand that my name and personal information will not be disclosed without my explicit consent. Voluntary Participation: I understand that my participation in the free health screening program is voluntary, and I am free to withdraw my consent and discontinue participation at any time without affecting my right to future care or treatment. My signature below indicates that I have provided true information on this form and have read, understand, and agree to all statements on the entirety of this form. Printed Name First Date of Birth MM slash DD slash YYYY Signature(Required)
