I, the undersigned First NameLast Name , am the parent or legal guardian of the child/youth named First NameLast Name , who was born on Date of Birth and resides in Street AddressAddress Line 2CityStateZip . For any situation, I assure that I will be available for the phone call at Area CodePhone Number . As a parent or legal guardian, I affirm that I have been completely informed of all Boldly Poised activities that the child/youth will participate. I understand the general structure of the activities/programs, including but not limited to, being included in pictures/photos, videos for the organization that will be posted on social media and the website/internet advertisement and marketing content. My child has/had the following conditions/diseases: ChickenpoxMeaslesMumpsAsthmaSinusitisBronchitisDiabetesHeart TroubleOther Conditions/Diseases , and have these allergies: Insect StingPollenNutPoison Ivy, OakSoyWheat, Other Allergies. I hereby voluntarily release, forever discharge the community, the corporation, its officers, directors, employees, volunteer and agents from any and all claims, demands, or causes of action, which are connected with my child's participation in the programs or the use of the equipment and facilities. I agree to pay for any and all medical expenses incurred and give permission to the doctor or health care professional to provide medical care if necessary. The information I've given in this form is complete and accurate. By signing this form on Date , I confirm that I have fully informed myself of the contents of this Parental Consent and Release Form by reading it before I signed it. I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect. SignatureFirst NameLast Name