Youth Campfire and Nature Walk Form

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Immigrant Outreach Society during the selected date. In exchange for the acceptance of said child’s candidacy by  Immigrant Outreach Society., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Immigrant Outreach Society and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected activity.

In case of injury to said child, I hereby waive all claims against Immigrant Outreach Society including all staff and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball and soccer. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death. 

Photo Release Form

I hereby grant the Immigrant Outreach Society permission to use the child in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. 

I understand and agree that all photos will become the property of the Immigrant Outreach Society and will not be returned.

I hereby irrevocably authorize Immigrant Outreach Society to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge Immigrant Outreach Society from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Medical Release and Authorization

As Parent and/or Guardian of the named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Immigrant Outreach Society and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.