I gave permission to the C-HIT Summer Journalism Workshop and their staff to treat the above mentioned participant for routine medical procedures, including dispensing of over the counter medications and to treat the participant in case of emergency situations or hospitalizations including surgical procedures. I have fully answered the questions on this form and have provided complete medical information relevant to the proper care and treatment of participant. I understand that the omission of information can jeopardize the participant's health, safety and overall program experience. I give permission to the C-HIT staff to share the minimum necessary information related to the physical and mental health of the above participant with appropriate C-HIT staff, and if necessary with medical providers and/or emergency personnel. I expect that the information shared will be respected as confidential by C-HIT staff.