Parental Consent Form

3P America’s “Safe Set” EZ-Onboarding © program requires that ALL cast and crew under the age of 18 have a parent or legal guardian complete a “Safe Set” Parental Consent Form prior to 3P America collecting any data or issuing a “Safe Set” Approved status.

Please note that all information provided is subject to our Privacy Policy and Terms & Conditions. 3P America will make every conceivable effort to maintain the safety and security of all our clients’ information. Securing your personal data is our priority!

Parental Consent Form

THIS FORM PROVIDES CONSENT TO COVID TESTING AND RELEASE FOR THE APPROPRIATE USE AND DISSEMINATION OF DATA FOR A MINOR UNDER THE AGE OF 18.

I, (name of parent / legal guardian) *

First

Middle

Last

the parent or legal guardian of (minor’s name) *

First

Middle

Last

born, (minor’s date of birth) *

do hereby give consent to 3P America, LLC as well as it’s partners, designated services, and affiliates for my child to complete a COVID-19 nasal swab test and for the storage of said minor’s personal data to be used solely for the validation and delivery of test results. I/We authorize 3P America, LLC to designate, identify, or contract with 3rd party COVID Testing solutions and services. I/We additionally allow test results to be released to the minor’s employer, manager, or administrator at their discretion, via these designated services and/or affiliates. *

I CONSENT

Release

I/We recognize that 3P America, LLC and its partners, designated services, and affiliates may contract with other physicians’, lab services or other providers’ services in order to fully service the deliverables of the “Safe Set” COVID Compliance Program. External providers are independent of 3P America, LLC and may utilize the 3P America, LLC platform or their own software and services as a way to communicate with patients. Information, advice, or results received from a provider or lab may potentially come from those providers' software, services, or platforms, and not from 3P America, LLC. The patient interactions with the providers via 3P America, LLC are not intended to take the place of a relationship with a patient’s regular health care practitioners. Neither 3P America, LLC, nor any of its subsidiaries or affiliates or any third party who may promote the 3P America “Safe Set” COVID Compliance Program, shall be liable for any professional advice or test result obtained from a health care provider via any 3P America service or for any other information obtained from 3P America’s records system, personnel or website. Additionally, YOU as the parent or legal guardian agrees to indemnify, release, and hold harmless 3P America, LLC, its partners, designated services, and affiliates from and against any loss, costs, claim, or liability stemming from any of their services, referred services, related affiliates, or providers, for failure to abide by the applicable state or federal laws or regulations. Likewise, 3P America, LLC or any of its independently contracted providers or service partners will not be responsible for any loss, cost, claim, or liability incurred by the parent / legal guardian, or other related independent parties. *

I CONSENT

Please Provide Your Preferred Contact Email Address *

Your email address will serve as our primary point of correspondence if we need to contact you regarding the minor.

May we contact you by PHONE if necessary regarding your minor? *

We will only contact you regarding issues related to your minor or this consent form.

Please provide the primary address at which the minor resides (OPTIONAL):

Address Line 1

Address Line 2

City

State

Zip Code

This information is used only to establish a home location for the minor in the event of an emergency.

By digitally signing this form, you CONSENT to COVID-19 Testing by 3P America, LLC and/or it's partners and/or affiliates for the purposes of the "Safe Set" COVID Compliance Program and release for, the only as necessary, dissemination of data pertaining to the above named minor to which you are the Parent or Legal Guardian of. *