The health information provided above is correct so far as I know. The person herein described has permission to engage in all activities except as noted. I hereby give permission to the Adult-In-Charge to provide routine health care. I consent for my child to receive such medical treatment and/or surgical procedures as are deemed necessary in the event of an emergency and to assume liability for any medical expenses involved. This authorization extends to my child’s participation in any activity sponsored by MITY. Should a medical emergency arise during my child’s participation in a MITY-sponsored activity, I understand that reasonable efforts will be made to contact me or my designated alternate at the phone numbers I have given. If it is believed my child’s life or health may be adversely affected by the delay that an attempt to contact me or my designated alternate would cause, I consent to the administration of medical treatment and/or surgical procedure deemed necessary by the medical doctor and/or medical facility and the immediate administration of life-sustaining measures deemed necessary under the circumstances.

I authorize Minnesota Institute for Talented Youth to use any photos or video of my student for presentations, advertising, publicity and promotion. MITY will never use a student's name.

I have read and understand MITY's Refund Policy.

By signing below, I acknowledge that both the student named above and myself, as their parent or legal guardian, have read and agree to abide by the MITY Code of Conduct. I understand that violations of these rules or any other inappropriate conduct may result in discipline, including dismissal from the program. Students who are asked to leave the program for discipline issues will not receive a tuition refund.

Once you submit the application you cannot go back. If you have any questions or wish to make changes to your application, please contact the MITY office at 651-243-2221 or info@mity.org.