Managing Chronic Health Needs in Child Care and Schools—Spina Bifida
  • Print
  • Share
    • Email

      Share a Pediatric Patient Education Handout

      Recipient(s) will receive an email with a link to 'Managing Chronic Health Needs in Child Care and Schools—Spina Bifida' and will not need an account to access the content.

      Enter each recipient's email address. At least one recipient is required.

      Subject: Pediatric Patient Education from the AAP –

      ×
    • Facebook
    • Twitter
  • PDF
  • Custom Handout


What is spina bifida?

Spina bifida means cleft spine, which is an incomplete closure in the spinal column. A closed defect is characterized by spinal tissue that is covered by skin. An open defect is characterized by spinal tissue that is not covered by skin. The 4 types of spina bifida are 
  •  
    Spina bifida occulta: One or more of the vertebrae (bones) of the spinal column has an opening without damage to the spinal cord.
  •  
    Occult spinal dysraphism (OSD): The child has a minor abnormality of the skin overlying the lower spine, such as a hairy patch, a pigmented area, or a small opening (sinus). The spinal cord below this abnormality is at high risk for injury as the child grows.
  •  
    Meningocele
     
    •  
      Meninges, the protective covering around the spinal cord, have pushed out through the opening in the vertebrae in a sac called the meningocele. However, the spinal cord remains intact.
    •  
      This form of spina bifida can be repaired with little or no damage to the nerve pathways.
  •  
    Myelomeningocele: This form of spina bifida is the most severe: a portion of the spinal cord itself protrudes through the back.

How common is it?

  •  
    The most severe forms occur at approximately 0.3 out of every 1,000 births.
  •  
    Of these newborns, the majority (94%) has myelomeningocele, and the rest (6%) have meningocele and OSD.

What are some common characteristics of children who have spina bifida or of spina bifida as children present with it?

  •  
    Muscle weakness: Children with myelomeningocele usually have muscle weakness or paralysis below the area of the spine where the incomplete closure (or cleft) occurs. Children may need wheelchairs or may be able to use crutches or walkers.
  •  
    Sensation disturbances: Children may not feel sensation in their limbs or body parts below the cleft.
  •  
    Bowel and bladder problems: Children with spina bifida usually do not develop normal bowel and bladder control, because this control depends on sacral nerve-root function. Many children with myelomeningocele need special assistance to learn to manage their bowel and bladder functions. Most require catheterization, specifically the insertion of a tube to permit the passage of urine. Many require medications to try to optimize bladder and bowel functions.
  •  
    Latex allergy: All children with spina bifida should avoid latex because of risk of allergy.
  •  
    Hydrocephalus: In addition, this condition may cause an accumulation of fluid in the brain, or hydrocephalus. (See Hydrocephalus and Shunts Quick Reference Sheet for more details.)
     
    •  
      It is estimated that 70% to 90% of children born with myelomeningocele have hydrocephalus.
    •  
      The higher the abnormality is on the spine, the greater the risk for hydrocephalus.
    •  
      Hydrocephalus is controlled by a surgical procedure called shunting, which relieves the fluid buildup in the brain.
    •  
      Before shunting was available, most children born with a myelomeningocele died shortly after birth. Now that surgery to drain spinal fluid and protect children against hydrocephalus can be performed early in life, children with myelomeningocele are more likely to live.
    •  
      Often, however, they must undergo a series of operations, including shunt revisions, throughout their childhoods.
  •  
    Vision problem: Children with spina bifida may have problems with their eyes or vision.
  •  
    Approximately 10% to 15% of children with spina bifida also have seizure disorders.

Who might be on the treatment team?

  •  
    In addition to the primary health care professional who ensures that the child receives routine preventive care services, many pediatric specialists are involved in the care of children with spina bifida. Pediatric developmental and rehabilitation specialists, neurosurgeons and orthopedic surgeons, neurologists, gastroenterologists, and urologists often work together in a multispecialty center to address and coordinate the medical needs of these children.
  •  
    Many children with spina bifida benefit from physical therapy, occupational therapy, or speech-language therapy to learn adaptive skills and how to function with their peers.
  •  
    Children who are younger than 3 years (ie, 36 months) may receive these therapies through early intervention services. Early intervention is a system of services to support infants and toddlers with disabilities and their families.
  •  
    For children 3 years and older, most have learning disabilities that require support. Special education and related services are available through the public school to provide the therapies and educational supports necessary for school achievement.

What are some elements of a Care Plan for children with spina bifida?

  •  
    Care Plans for children with spina bifida often include intermittent catheterization, a procedure during which a tube is placed into the bladder and urine is drained, usually at least 3 times per day. Care Plans also need to provide support for fecal incontinence, which is as common as urinary incontinence in children with spina bifida.
  •  
    The Care Plan may also incorporate physical or occupational therapy exercises into a daily routine.
  •  
    These plans may include mobility aids such as wheelchairs, walkers, splints, braces, communication devices, and adapted toys to help children be more active, participate more, and have fun while they are working their bodies.
  •  
    Exposure to latex (eg, rubber-containing toys, bandages) should always be limited to prevent development of latex allergy and managed in those who have already developed sensitivity to it.
  •  
    A written plan called the Individualized Family Service Plan will be provided for children in early intervention programs.
  •  
    An Individualized Education Program will describe an older child’s unique needs and the services available to address them.
  •  
    These children should have at least one visit with a qualified pediatric ophthalmologist (an eye specialist).

What adaptations may be needed?

Physical Environment and Other Considerations

  •  
    Many children learn self–intermittent catheterization at an early age, sometimes as young as 5 years. A private area in which this insertion can be done is helpful.
  •  
    A successful bladder and bowel management program can be incorporated into the school day or child care program.
  •  
    Architectural factors need to be considered when caring for a child with spina bifida. Ramps, ground-floor entrances, and wheelchair-accessible areas may be needed. In addition, schools should help ensure that handicapped-accessible playgrounds and activities are available, so the social interaction between children with spina bifida and typically developing children can occur.
  •  
    Children with spina bifida have varying physical capabilities and limitations. Work with the child’s family and therapists on goals to improve the child’s mobility without increasing child or family frustration with the child’s limitations.

What should be considered an emergency?

  •  
    If the child has a seizure, follow emergency guidelines for seizures (see Seizures, Febrile, Quick Reference Sheet).
  •  
    Notify parents/guardians of
     
    •  
      Fever
    •  
      Severe headache, lethargy, irritability, or new eye crossing
    •  
      Numbness or tingling in the limbs
    •  
      Any loss of function (eg, weakness in the legs)
    •  
      Inability to obtain urine with catheterization
    •  
      Any sign of allergic reaction, especially if latex exposure is suspected
  •  
    Children with spina bifida may need extra time, supervision, or transport in case of an emergency such as a fire.
  •  
    Any critical adaptive equipment and supplies would also need to be brought in an evacuation.

What types of training or policies are advised?

  •  
    Catheterization
  •  
    Care Plan specifics
  •  
    Safe transfer or transportation
  •  
    Children with spina bifida are more likely to miss school because of medical visits and medical emergencies or because of care issues. School providers should work to ensure that children and adolescents with spina bifida are provided appropriate supports to address these necessary absences.

What are some resources?

Spina Bifida Association: 

Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.

Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

×

Why create an account?

If your institution provides your access to this website, you may link that access to your individual AAP account. You may then access the website remotely and unlock features for individual accounts. To do so, sign in to your AAP account any time you are actively authenticated on the website via your institution (look for your institution’s name in the sign-in box to verify authentication). Once signed in, your account will be linked to your institution’s access for 120 days, after which you must repeat the process for continued access.

×

You must be signed into an individual AAP account to use this feature.

Please sign in to your AAP account in order to use this feature. If you need an AAP account (free for anyone to register an account), please click on "Create Account" below and complete the one-time registration form.

  • Forgot password or AAP Login?
  • Create Account
  • Want remote access to your institution's subscription?
This is the touchback warning message modal.
×
×

TERMS AND CONDITIONS

GOVERNING USE OF WEBSITE AND MATERIALS

The following terms and conditions are an agreement (the “Agreement”) governing your access and use of the [Pediatric Care Online (PCO)] website (the “Website”) and its content (collectively, the “Materials”). Please read these terms carefully. If you agree to all of the terms of this Agreement please click the “I Agree” button below to indicate your acceptance and you will automatically be taken to the Website. If you do not wish to be bound by these terms, you may not access or use the Materials - in such event you should click the “I Do Not Agree” button below and follow the instructions to obtain a refund of any subscription fees paid by you.

1. Materials. The American Academy of Pediatrics (“AAP”) hosts the Website and related Materials on its servers and makes them available via the Internet to subscribers for non-commercial research and education purposes and for use in providing healthcare services. In consideration of payment of the applicable subscription fee, the AAP is willing to provide access to the Materials to you and, if applicable, your Users (as defined below), subject to all of the following terms. You acknowledge that certain portions or content of the Website or Materials may contain information, materials or content provided by a third party provider or licensor (a “Provider”) and that the liability and obligations of such Providers is limited as provided herein.

2. Access and License.

(a) Subject to the terms of this Agreement, the AAP grants to you a non-exclusive, non-assignable and non-transferable right to access and use the Materials for the purpose of providing healthcare services to your patients (the “License”).

(b) “User” means you and your authorized users for whom a subscription has been activated. For individual enrollment use of the Materials is limited solely to you, and you agree not to permit others to access the Materials using your account. For group enrollment, access to the Materials is limited to you and your authorized Users for whom you have obtained an authorized subscription. You agree not to permit others to access the Materials using your account. You agree to issue passwords or other access information only to authorized Users and use reasonable efforts to ensure that Users do not divulge their passwords and other access information to any third party.

(c) You agree to make all Users aware of, and ensure that all of your Users comply with, all of the terms of this Agreement. You will monitor compliance of your Users with the terms of this Agreement. You acknowledge that you will be held responsible for any access or use of Materials traceable to your Users and/or User ID. You agree to immediately notify us in the event you determine, or have reason to believe, that an unauthorized party has gained access to the Materials and to take all reasonable steps, both to ensure that such activity ceases and to prevent any recurrence.

(d) Under the License, Users are only permitted to:

(i) Access and display the Materials in connection with providing healthcare services.

(ii) Electronically save and print off individual parts or documents of the Materials for personal use in connection with providing healthcare services.

(iii) Distribute the Materials in print or electronic form to other Users for the purposes of providing healthcare services.

(iv) Supply a printed copy of individual documents or parts of the Materials to individual patients of a User on request or on an ad-hoc basis in connection with providing healthcare services, provided that such dissemination does not result in distribution of a substantial or material portion or volume of the Materials to such patient.

(v) Supply print or electronic copies of individual documents from the Materials to governmental authorities for legal or regulatory purposes.

(e) You are responsible for furnishing, at your expense, any computer, networking, telecommunications and other equipment necessary for you or your Users to access the Internet and connect to the Website and Materials.

(f) The AAP shall use commercially reasonable efforts to cause the Website and Materials to be accessible to the Internet twenty-four (24) hours each day except for scheduled maintenance and required repairs, and except for any interruption due to causes beyond the reasonable control of the AAP. The AAP and its Providers do not warrant that access to the Materials or Website will be uninterrupted or error free or that any information, software, or other materials available on or accessible through the Materials or Website is free from viruses, worms, Trojan horses, or other harmful components. THE AAP AND ITS PROVIDERS WILL NOT BE LIABLE FOR DAMAGES OR REFUNDS SHOULD THE WEBSITE OR MATERIALS BECOME TEMPORARILY UNAVAILABLE OR IF ACCESS TO THEM OCCASIONALLY BECOMES SLOW OR INCOMPLETE. In no event shall the AAP or its Providers be liable for downtime, system speed or slow-down caused by the misoperation or failure of the Internet or any other network not under the sole control of the AAP or by any other cause beyond the reasonable control of the AAP or its Providers. The AAP will restore access to the Website and Materials as soon as commercially practicable in the event of an unscheduled interruption or failure thereof.

3. License Restrictions. The License shall be subject to the following restrictions and conditions, and without the separate written approval of the AAP neither you nor any User shall:

(a) Use, or permit any third party to use, the Materials for any purposes other than in connection with providing healthcare services to Users’ patients.

(b) Distribute, publish or make available any part of the Materials (in print or electronic form) to anyone other than Users or Users’ patients except as explicitly permitted herein.

(c) Remove, obscure, or change any copyright notices, author identification, disclaimers or other proprietary legends incorporated in the Materials.

(d) Alter, abridge, adapt or modify the Materials or prepare derivative works based upon the Licensed Materials or incorporate the Materials into other materials, nor permit third parties to do so.

(e) Make the Materials available to the public via the Internet, World Wide Web or other un-secure network (except pursuant to features or functionality specifically built into the Website or Materials to facilitate such access).

(f) Make agreements for access to the Materials with individuals, organizations, vendors, affiliates, or partners, who are not your individual Users.

(g) Use, or allow the use of, the Materials in contravention of any federal, state, local, foreign or other applicable law, or any rules or regulations of regulatory or administrative organizations.

4. Changes to the Materials. The AAP reserves the right at any time, in its discretion, for any reason and without prior notice: (i) to change, suspend or discontinue any aspect of the Materials, including the availability of any feature, database or content; (ii) to limit or restrict user access to certain features available on the Materials; and (iii) to suspend users use of the Materials, temporarily or permanently; provided that in the event any such change materially affects your ability to use the Materials or makes them materially less useful to you, then you may, within thirty (30) days of the change, terminate this Agreement by giving fifteen (15) days written notice to the AAP, and the AAP will refund any unearned portion of your subscription fee. If the AAP gives you notice that it is withdrawing materials because it no longer retains the right to publish them or that it has reasonable grounds to believe they infringe copyright or are defamatory, obscene, unlawful or otherwise objectionable, then you agree promptly after receipt of such notice to take all commercially reasonable efforts to prevent further access to the applicable Materials by Users.

5. Fees. You agree to pay to the AAP the current subscription fee detailed at enrollment or otherwise provided on the Website, including the then-current fee during any renewal term. The AAP reserves the right, without prior notice, to suspend your use of the Materials if owed fees are past due.

6. Term and Termination.

(a) The initial term (“Term”) of this Agreement will be for the period corresponding to the subscription fee that you have paid. The Term will automatically extend for additional renewal periods for which you subsequently pay the then-current subscription fee. This Agreement and your and your Users’ right to access and use the Materials will automatically expire at the end of the Term.

(b) The AAP may terminate this Agreement by giving notice to you if you or one of your Users materially breaches any provision of this Agreement.

(c) Upon termination of the License for any reason, you and your Users shall immediately cease all further use and distribution of the Materials. The following rights and obligations shall survive any termination: (a) any obligation that matured prior to the effective date of the termination or expiration; and (b) Sections 7(b), 8, 9, 10 and 11.

7. Trademarks and Approvals.

(a) You are authorized to use the AAP’s trademarks, logos and brand names (the “AAP Trademarks”) only in connection with reproducing any such AAP Trademarks as incorporated in the Materials. You may not make any other uses of the AAP Trademarks, including uses in promotional and marketing materials, advertising, and web pages, without the AAP’s prior written approval, to be granted in the AAP’s sole discretion. You agree not to distribute, display or publish any such materials without such approval.

(b) You acknowledge that the AAP is the sole and exclusive owner of the AAP Trademarks and that any use by you shall inure solely to the benefit of the AAP. Upon termination of this Agreement for any reason, you agree to cease use of the AAP Trademarks.

8. Proprietary Rights.

(a) As between you and the AAP, title to and ownership of the Materials and all materials and data provided by the AAP in connection with this Agreement, any materials or other derivative work based on or derived therefrom or improvements thereto, and all copyrights and associated intellectual property rights, will belong to the AAP. To the extent that any such items are not deemed a work-made-for-hire or you otherwise retain rights therein, you agree to and hereby grant, assign and convey to the AAP all of your right, title and interest, if any, in such items and in all patents, copyrights and other intellectual property rights therein. You agree to cooperate fully with the AAP for the purpose of securing, reserving and protecting the AAP’s rights in such items, including executing any documents requested by the AAP. The only rights to the Materials granted to you are the rights to use the Materials in accordance with the License and all rights not specifically granted herein are reserved by the AAP.

(b) You acknowledge and agree that at all times the Materials, including any portion or alteration of the Materials and any derivative work based on the Materials, shall belong to the AAP and may only be used in accordance with the terms of this Agreement.

9. Disclaimer of Warranties.

(a) Although the AAP believes the information in the Materials to be accurate and timely, because of rapid advances in the field of pediatrics medicine and our reliance on information provided by outside sources, the AAP and its Providers make no warranty or guarantee concerning the content of the Materials, including the accuracy or reliability of the content in the Materials, or on other sites to which we link. When clinical matters are discussed, the opinions presented are those of the discussants only. The material discussed in the Materials is not intended to present the only or necessarily the best pediatric method or procedure, but rather presents the approach or opinion of the discussant. You acknowledge that the recommendations and information in the Materials do not indicate an exclusive course of treatment or serve as a standard of medical care. You and your Users assume full responsibility for the appropriate use of medical information contained in the Materials, and you agree to hold the AAP and its Providers harmless from any and all claims or actions arising from you or your Users’ use of the Materials in accordance with Section 10(e).

(b) THE MATERIALS AND WEBSITE AND THE INFORMATION, SOFTWARE, AND OTHER MATERIAL AVAILABLE ON OR ACCESSIBLE THEREFROM ARE PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS WITHOUT WARRANTIES OF ANY KIND, EXPRESSED OR IMPLIED, INCLUDING BUT NOT LIMITED TO REPRESENTATIONS OR WARRANTIES REGARDING TITLE, NONINFRINGEMENT, ACCURACY, TIMELINESS OR COMPLETENESS OF THE INFORMATION CONTAINED IN THE MATERIALS, OR IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR PARTICULAR PURPOSE, ALL OF WHICH THE AAP AND ITS PROVIDERS DISCLAIM. If implied warranties may not be disclaimed under applicable law, then ANY IMPLIED WARRANTIES ARE LIMITED IN DURATION TO A PERIOD OF SIXTY (60) DAYS FROM THE DATE THE MATERIALS ARE FIRST ACCESSED BY YOU. Some states do not allow limitations on how long an implied warranty lasts, so the above limitation may not apply to you. This warranty gives you specific legal rights, and you may also have other rights which vary from state to state.

10. Limitation of Liability and Damages.

(a) The AAP shall indemnify, defend and hold you, and your affiliates, and Users harmless from and against any loss, damage, costs, liability and expenses (including reasonable attorney fees) arising out of any legal action taken against such entities claiming that the Materials used as contemplated by this Agreement infringe the U.S. copyright or any other U.S. proprietary or intellectual property rights of any person. The AAP shall have no obligation under this Section for any such claims, actions or losses which are based upon: (i) you or your Users’ use of the Materials in a combination with materials or products not supplied by the AAP which violate the rights of third parties, (ii) the modification of the Materials or the use or distribution of such modified content, or (iii) use of the Materials in a manner other than that permitted herein.

(b) UNDER NO CIRCUMSTANCES SHALL THE AAP OR ITS PROVIDERS BE LIABLE TO YOUR OR ANY AUTHORIZED USER OR OTHER PERSON FOR ANY DIRECT, INDIRECT, CONSEQUENTIAL, INCIDENTAL, SPECIAL EXEMPLARY, PUNITIVE OR OTHER DAMAGES (INCLUDING WITHOUT LIMITATION LOSS OF PROFITS, PERSONAL INJURY/WRONGFUL DEATH OR DAMAGES RESULTING FROM LOST DATA OR BUSINESS INTERRUPTION), ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT OR THE USE OR INABILITY TO USE THE MATERIALS OR WEBSITE, YOUR RELIANCE ON OR USE OF THE INFORMATION PROVIDED IN THE MATERIALS, OR THAT RESULT FROM MISTAKES, OMISSIONS, INTERRUPTIONS, DELETION OF FILES, ERRORS, DEFECTS, DELAYS IN OPERATION OR TRANSMISSION, OR ANY FAILURE OF PERFORMANCE, WHETHER BASED ON WARRANTY, CONTRACT, TORT, OR ANY OTHER LEGAL THEORY, AND REGARDLESS OF WHETHER THE AAP OR ITS PROVIDERS OR AGENTS KNOWS OR HAS REASON TO KNOW OF THE POSSIBILITY OF SUCH DAMAGES.

(c) IN NO EVENT SHALL THE AAP OR ITS PROVIDERS BE LIABLE TO ANY PARTY FOR ANY ADVERSE CONSEQUENCES ARISING FROM INDEPENDENT APPLICATION OF THE CONTENT OF THE MATERIALS TO PARTICULAR CIRCUMSTANCES NOR FOR YOUR OR YOUR USERS’ RELIANCE ON THE WEBSITE OR MATERIALS FOR ANY PURPOSE.

(d) EXCEPT FOR CLAIMS BROUGHT PURSUANT TO SECTION 10(a), THE AAP’S AND ITS PROVIDERS’ LIABILITY (WHETHER IN CONTRACT, TORT, NEGLIGENCE, STRICT LIABILITY IN TORT OR BY STATUTE OR OTHERWISE) TO YOU OR TO ANY THIRD PARTY FOR ANY AND ALL CLAIMS RELATED TO OR ARISING OUT OF THIS AGREEMENT OR THE MATERIALS, SHALL NOT IN THE AGGREGATE EXCEED THE FEES PAID BY YOU HEREUNDER IN THE TWELVE (12) MONTHS PRIOR TO THE OCCURRENCE GIVING RISE TO THE CLAIM.

(e) Except as to those matters for which the AAP is obligated to indemnify you under Section 10(a), you agree to indemnify, defend and hold the AAP and its Providers and agents harmless from and against any loss, damage, costs, liability and expenses (including reasonable attorney fees) arising out of your or your Users’ use of the Materials, including any claim or legal action taken against the AAP or its Providers or agents related to or in any way connected with (i) any use of the Materials by Users or (ii) any failure by you to perform your obligations in relation to this Agreement.

(f) Certain portions of the Website or Materials may contain information or content provided by Mead Johnson & Company for use in connection with the Website as a sponsor of the Website (“Mead Johnson Content”). With the sole exception of Mead Johnson Content, Mead Johnson & Company is not the author of, nor responsible for, the content of the Website or Materials. You agree that Mead Johnson & Company’s liability and obligations are limited as a Provider in accordance with the terms of this Agreement, including Sections 9 and 10 herein.

(g) Certain portions of the Website or Materials may contain medical reference information or database content provided by Lexi-Comp, Inc. for use in connection with the Website (“Lexi-Comp Content”). You agree that Lexi-Comp, Inc.’s liability and obligations are limited as a Provider in accordance with the terms of this Agreement, including Sections 9 and 10 herein. The Lexi-Comp Content is intended to serve the user as a rapidly accessible, concise initial reference resource and not as a complete reference resource. It does not include information concerning every therapeutic agent, laboratory or diagnostic test or procedure available. The Lexi-Comp Content is clinically oriented and is intended to be used only by Users who are: (1) researchers who will not use the information for medical diagnosis or treatment, and (2) physicians and other competent healthcare professionals who will rely on their own discretion and judgment in medical diagnosis and treatment. Neither the AAP nor its Providers directly or indirectly practice medicine or dispense medical services and, as such, assume no liability for data contained in the Lexi-Comp Content. You and your Users assume full responsibility for the appropriate use of medical information contained in the Lexi-Comp Content, and you agree to hold the AAP and its Providers harmless from any and all claims or actions arising from your or your Users’ use of the Lexi-Comp Content.

11. General .

(a) Force Majeure. Except for your obligations hereunder to pay the AAP, neither party shall be responsible for delays or failures in performance resulting from acts or circumstances beyond the control of such party, including, without limitation, acts of God, strikes or other labor disputes, riots, acts of war, malfunction of portions of the Internet or another third party network, governmental regulations promulgated after the effective date of this Agreement, communication line failures, power failures, equipment failures, fires or other disasters, and acts of third parties including hackers and crackers.

(b) Changes to this Agreement. The AAP reserves the right to change or modify this Agreement at any time by presenting you with a new set of terms before you access the Materials. Following your agreement to such modified Agreement, this Agreement shall be of no further effect and the modified agreement shall control. In the event you refuse to agree to any such new agreement, the AAP will, if requested, refund any unearned portion of your subscription fee.

(c) Political Activities. The AAP is a Section 501(c)(3), not-for-profit corporation, and as such, does not participate in any political activities. You are prohibited from participating in political activities while using the Materials or the Website.

(d) Governing Laws and Venue. This Agreement will be governed by the laws of the State of Illinois applicable to contracts made and to be performed in that state. The parties hereby submit to the exclusive jurisdiction of the federal and state courts located in Cook County, Illinois, U.S.A. to resolve disputes related to this Agreement or the Materials.

(e) Waiver and Severability. A waiver of any breach or default under this Agreement shall not constitute a waiver of any other right arising out of any subsequent breach or default. Either party's failure to enforce any term of this Agreement shall not constitute a waiver of any rights to enforce subsequent breaches. If any term of this Agreement is held to be invalid, the parties agree that such invalidity will not affect the remaining terms.

(f) Notice. Any notice required under this Agreement shall be in writing and sent to the other party’s address shown on the Website or provided during enrollment, or such other address as may be provided by each party from time-to-time. Notices shall be effective when received.

(g) Assignment. Neither party may assign this Agreement to any third party without the prior written consent of the other party.

(h) Entire Agreement. This Agreement and any attachments represent the entire agreement between the parties and supersede any previous contemporaneous oral or written agreements, commitments, representations or communications regarding the subject matter of this Agreement. Any modification to this Agreement must be in writing and signed by a duly authorized agent of both parties. Signed facsimile copies of this Agreement, and attachments will legally bind the parties to the same extent as original documents.

(i) Privacy and Compliance with Law. Each party shall comply with all applicable laws and regulations in exercising its rights and performing its obligations hereunder. Collection and use of personal information in connection with the Website is subject to the AAP’s privacy policy posted on such Website. Despite any representations concerning privacy, the AAP reserves the right to disclose without notice to you any information in our possession if required to do so by law or upon a good-faith belief that such action is necessary to comply with the law, to protect or defend our rights or property, or to respond to an emergency situation.

By clicking on the “I AGREE” button below, (1) YOU AGREE TO ALL OF THE TERMS OF THIS AGREEMENT, (2) YOU ARE CONSENTING TO ENTER INTO THIS AGREEMENT IN ELECTRONIC FORM AND (3) YOUR CLICK SHALL CONSTITUTE YOUR ELECTRONIC SIGNATURE ACCEPTING THIS AGREEMENT. Any person accepting this Agreement on behalf of another entity further represents and warrants that such individual is a duly authorized representative, having the power and authority to bind such entity to this Agreement. If you do not wish to be bound by these terms, you may not access or use the Materials - in such event you should click the “I Do Not Agree” button below and follow the instructions to obtain a refund of any subscription fees paid by you.

I DO NOT Agree I Agree