I grant permission for my child, First Name* Last Name* , to be a part of the Operation Work (OW) program for young men. I will have him ready for all activities. My child has permission to go on all field trips and I give permission for my child to be transported by the staff of Operation DREAM in Operation DREAM vehicles, when conveyance is necessary. I will not hold the staff, Operation DREAM or its sponsors liable for any accidents, injuries or lawsuits.
I grant permission for photographs and /or audiotapes of my child to be used by Operation DREAM and its agents for public relations and /or program evaluation purposes.
I certify that the above information is true to the best of my knowledge. In the event of injury or should emergency care be required; I authorize Operation DREAM staff to arrange for emergency medical attention at the nearest medical facility and render whatever medical aid may be judged necessary by an attending physician for my child. I authorize my insurance benefits be paid directly to the physician. I understand that I am financially responsible for any balance. I also authorize [Name of Practice] or insurance company to release any information required to process my claims. I understand that it is my responsibility to monitor my child’s participation in Operation DREAM activities based on any physical or medical limitations that my child has that would inhibit his/her participation. The person herein described has permission to participate and engage in all activities; except as noted here: