Consent For Minors To Participate in Activities Outside SCDMH by 45GhV20m

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									CONSENT FOR MINORS TO PARTICIPATE IN ACTIVITIES OUTSIDE SCDMH
                        PROPERTY




Patients participate in activities outside the hospital grounds only with the Doctor’s permission.
Any minor participating in activities outside the hospital setting must have the consent of the
parent, guardian or personal representative. All groups of patients off the grounds will be
supervised by hospital employees. I understand that the minor may be recognized or identified
as a patient of the SC Department of Mental Health.


I have read and understand the above statements and agree that:


                                                     May participate in activities off the hospital grounds.




                             (Date)                         Signature of Authorized Consenting Person




                                                                        Relationship to Patient




SCDMH FORM
NOV. 02 (REV. DEC. 05) CBHS @ WSHPI – 137 (ENLISH)

								
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