Southwest MN Hacks: Fall 2026 Parent/Guardian Consent & Medical Authorization

Southwest MN Hacks: Fall 2026 Parent/Guardian Consent & Medical Authorization
This form is required for any participant under the age of 18 who plans to attend Southwest MN Hacks: Fall 2026. A parent or legal guardian must complete and sign this form before the participant can be admitted to the event.

Event Date: Saturday, September 12, 2026, at 8:00 AM through Sunday, September 13, 2026, at 10:00 AM
Location: Southwest Minnesota State University, Upper Conference Center, 1501 State St, Marshall, MN 56258
Organizer Contact: support@southwestmnhacks.org

Southwest MN Hacks is organized in partnership with Aulden.
Participant Information
Participant Full Name

First NameMiddle NameLast Name
Participant email used during registration
example@example.com
School
Parent/Guardian Information
Parent/Guardian Full Name

First NameLast Name
Relationship to Participant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact
Emergency Contact Name
Relationship to Participant
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information
Known allergies, food, medication, environmental
Current medication, medical conditions or special needs we should be aware of
Dietary restrictions
Consent and Authorization
I, the undersigned parent or legal guardian, hereby give permission for the participant named above to attend and participate in Southwest MN Hacks: Fall 2026, an overnight hackathon event held at Southwest Minnesota State University from Saturday, September 12, 2026 (8:00 AM) through Sunday, September 13, 2026 (10:00 AM). I understand and acknowledge the following:
1. This is an overnight event and my child may be present at the venue throughout the night.
2. Overnight rest areas will be provided; they will be organized with appropriate supervision and participant safety procedures.
3. My child will be supervised by event organizers and designated volunteers throughout the event.
4. Food and beverages will be provided. I have listed any dietary restrictions or allergies above.
5. My child may use computers and technology equipment during the event.
6. My child is expected to follow the Southwest MN Hacks Code of Conduct (code-of-conduct) and may be removed from the event for unsafe, disruptive, or inappropriate behavior.
7. Alcohol, illegal drugs, and unauthorized substances are strictly prohibited at the event.
Medical Authorization: In case of emergency, I authorize event organizers to seek appropriate medical treatment for my child if I cannot be reached. I understand I will be contacted as soon as possible.
I acknowledge and agree to all of the above.
Photo and Video Release
Photo/Video Release
Overnight Permission
Overnight permission
Saturday pickup time

Hour Minutes

AM/PM Option
Sunday return time

Hour Minutes

AM/PM Option
Authorized pickup person(s)
Name

First NameLast Name
Relationship to Participant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship to Participant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship to Participant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Signature
I certify that I am the parent or legal guardian of the participant named above, that the information I have provided is accurate, and that I have read and agree to this form in its entirety.
Parent/Guardian Signature
Date

MonthDayYear
Date
Printed Parent/Guardian Name
Should be Empty:

Southwest MN Hacks: Fall 2026 Parent/Guardian Consent & Medical Authorization

Participant Information

Parent/Guardian Information

Emergency Contact

Medical Information

Consent and Authorization

Photo and Video Release

Overnight Permission

Authorized pickup person(s)

Signature