Acknowledgment of Non-Participation in Government Programs:

• The member(s) and/or the member(s) parent and/or legal guardian acknowledges and affirms that they are not enrolled in, nor receiving benefits from, any government-subsidized healthcare program, including but not limited to Medicare, Medicaid, TennCare, or Tricare.

• The member(s) and/or the member(s) parent and/or legal guardian further acknowledges that it is their sole responsibility to confirm their eligibility and non-participation in such programs prior to enrollment.

• The member(s) and/or the member(s) parent and/or legal guardian understands and agrees, that individuals who are enrolled in Medicare, Medicaid, TennCare, or any other government-subsidized healthcare program are not eligible to participate in the Covenant Medcare program and participation is strictly prohibited while enrolled in any such program.