BRIGHT CHOICE FOUNDATION
2026-2027 Parent/Guardian Consent & Medical Authorization Form
Parent/Guardian Consent
I hereby give permission for my child to participate in Bright Choice Foundation's programs and activities for the 2026-2027 program year, including mentoring programs, camps, educational activities, field trips, sports, swimming, and other recreational or educational activities organized or conducted by the Bright Choice Foundation.
I understand that Bright Choice Foundation staff, mentors, and volunteers will make every reasonable effort to provide a safe and responsible environment for all participants.
Emergency Medical Authorization
In the event of an accident, illness, or injury, and if a parent/guardian or emergency contact cannot be reached, I authorize Bright Choice Foundation staff or designated representatives to obtain or arrange reasonable and necessary emergency medical care for my child. I understand that I am responsible for providing accurate and current medical and emergency contact information.
Acknowledgment of Risk & Release of Liability
I understand that participation in Bright Choice Foundation programs may include activities such as swimming, soccer, sports, field trips, outdoor activities, transportation, and other recreational or educational activities that may involve inherent risks. I acknowledge and voluntarily assume the risks associated with my child's participation in these activities.
To the fullest extent permitted by applicable law, I release and hold harmless Southwest Civic Platform and its Education Department, directors, officers, employees, mentors, volunteers, and authorized representatives from claims arising from my child's participation in program activities, except to the extent such claims cannot legally be waived.
I have read and understand the program policies and rules and agree that my child and I will comply with applicable program rules and safety requirements.
Child's Name:
*
First Name
Last Name
Parent/Guardian Name:
*
First Name
Last Name
Parent/Guardian Signature:
*
Date:
*
-
Mois
-
Jour
Année
2 digit month, 2 digit day, 4 digit year
Date
Photo & Media Release / Consent
I understand that photographs or videos of my child may be taken while participating in Bright Choice Foundationprograms and activities. I authorize the Education Department to use photographs or videos of my child for program-related communications and promotional purposes, including printed materials, websites, social media, newsletters, and other digital or print publications.
Parent/Guardian Photo & Media Consent Signature
*
Back
Next
Medical Information
Please provide information about any medical conditions, allergies, illnesses, injuries, medications, dietary restrictions, or other health-related information that the Education Department should be aware of in order to appropriately support your child.
Additional Support Information
Please share any other health, behavioral, developmental, or learning-related information that may help us better support your child. This may include information regarding ADHD, learning accommodations, medications, behavioral needs, screen-time concerns, dietary needs, or other relevant considerations.
Insurance Information
Please submit a copy of your child's current health insurance card to be kept on file for emergency purposes.
Insurance Provider:
Policy / Member ID:
Bright Choice Foundation | 2026-2027
Submit
Should be Empty: