H.O.O.P. Foundation, Inc. Intake Form

PARENTAL AUTHORIZATION, LIABILITY WAVIER MEDICAL RELEASE FORM
In consideration for permitting my child to enroll and participate in the activities provided by HO.O.P. Foundation Inc. I, _____, being 18 years old, do for myself and on behalf of my child, _______, agree as follows: *
Parent/Guardian - Child Name
AUTHORIZATIONS
I (we) are the parent(s) or legal guardian(s) of the youth participant listed above and grant my (our) permission for him/her to participate fully in H.O.O.P. Foundation, Inc. activities and events. *
I (we) understand H.O.O.P. Foundation, Inc., volunteers and leaders will make every attempt to contact me (us) as soon as possible in the event an emergency arises. If I(we) can not be reached I (we) authorize H.O.O.P. Staff, volunteers and leaders to take my child to the doctor or hospital. i (we) also authorize medical treatment recommended by medical staff and I (we) assume responsibility for all medical bills *
I (we) understand that our child may be photographed or videotaped during activities and that these photos/videos may be used for promotional material published by H.O.O.P. Foundation, Inc. *
LIABILITY WAVIER, COVENANT TO HOLD HARMLESS & INDEMNIFY:
I (we), on behalf of my (our) child, assume the risk and promise to release, forever discharge and hold harmless H.O.O.P. Foundation, it's directors, staff, and volunteer leaders from any and all liability for personal injuries or sickness and damages to personal or public property which might result from my child's participation in any and all H.O.O.P. foundation activities, including being transported in H.O.O.P.'s vehicle, chartered, and chaperone vehicles, to and from the event destination(s). this covenant to old harmless extends to my (our) child's participation in H.O.O.P. Foundation events and activities *
I (we) agree to indemnify and hold harmless H.O.O.P. foundation, it's directors, staff, and volunteer leaders for any liability incurred or property damages/loss sustained by H.O.O.P. Foundation as the result of the negligent, willful, or intentional conduct of my (our) child, including expenses attendant thereto. *
I (we) hereby certify that I (we) have read and clearly understand these terms and that this authorization/waiver/ covenant is being executed voluntarily. *
(1) PARENT/LEGAL GUARDIAN MUST SIGN
Parent/ (1)

First Name Last Name
Parent (2)

First Name Last Name
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H.O.O.P. Foundation, Inc. Intake

Medical Insurance & Emergency Contact Parental Authorization, Liability Wavier Medical Release Form

PARENTAL AUTHORIZATION, LIABILITY WAVIER MEDICAL RELEASE FORM

AUTHORIZATIONS

LIABILITY WAVIER, COVENANT TO HOLD HARMLESS & INDEMNIFY:

(1) PARENT/LEGAL GUARDIAN MUST SIGN