Serve Orlando | Permission, Release, and Consent Form
Group Name
Service Dates
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Participant Name
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First Name
Last Name
Is this participant under the age of 18?
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Yes
No
Birthday
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-
Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Sex
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Male
Female
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Any allergies or other medical needs?
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Emergency Contact Name
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Emergency Contact Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Serve Orlando Permission, Release, and Consent FormI give permission for myself or my child (if under 18) to participate in activities with Serve Orlando (“SO”). I understand these activities may involve physical risks and affirm that I or my child is physically and mentally able to participate. I release and hold harmless SO, its staff, volunteers, and partners from any liability for illness, injury, or damages related to participation. If medical care is needed and my emergency contact cannot be reached, I authorize SO staff or leaders to seek necessary medical treatment as advised by a licensed provider. I have disclosed any relevant allergies, medications, or medical conditions. I also grant SO permission to photograph or record me or my child during activities for use in promotional or informational materials. By signing below, I acknowledge that I have read, understood, and agree to this Permission, Release, and Consent Form.
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Date Signed
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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