The information provided on this form is accurate to the best of my knowledge. I have indicated any special health conditions, including required medication which should be known to the program staff. I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill. I understand that Boston University and the Population Health Exchange are not responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.