Each year, parents of babies born at Neosho Memorial are invited to enter their child’s photo in the annual Carriage Club calendar project. Invitations to participate were mailed to babies born between April 1, 2022 and April 1, 2023. If you received an invitation, simply follow the instructions outlined in your letter and complete this online form. Finally, choose and upload your child’s photo.
Waiver: By participating in this project, I hereby, for myself and my child, grant Neosho Memorial and its affiliated institutions and businesses, exclusive rights to use this information for promotional activities. The material I have provided is reproducible and does not violate any copyright laws. With this entry, I, for myself and family, waive all rights and claims for damages I may have against Neosho Memorial Regional Medical Center and any individuals associated with the project.
Nondiscrimination statement: Neosho Memorial Regional Medical Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Interpretation services: ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-620-431-4000 (TTY: 1-620-431-6586). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-620-431-4000 (TTY: 1-620-431-6586). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-620-431-4000 (TTY: 1-620-431-6586).
Please verify the spelling of your child's name and address! The name will appear in the calendar as submitted on this form.
I understand that the PHI to be disclosed includes my child’s first and last name, and city and state of residence, as well as my child’s picture. This disclosure is being made at my request. This authorization shall remain in effect upon submission of the entry and shall remain in effect until 2029. I specifically understand that copies of the 2022 baby calendar may be distributed to the public throughout 2022. I also understand the calendar information may be distributed using other marketing methods. I understand that I may revoke this authorization at any time (except to the extent that action, such as publication of the calendar, has been taken in reliance on it) by mailing or hand delivering written notification to the following person: Privacy Officer, NMRMC P.O. Box 426 Chanute, KS 66720