Parental Consent and Waiver of Liability
Young Celina Ladies of Influence
Parental Consent and Waiver of Liability
This form is designed to obtain your permission for your child to participate in the Celina Young Ladies of Influence (yCLOI), a youth program run and supported by the Celina Ladies of Influence (CLOI). Inconsideration for my child’s participation in any yCLOI trips and activities, I expressly hold harmless from and waive the CLOI members and volunteers and assigns any an all claims for medical expenses, loss of services, injury to person or property, death, or other claims, actions, or liabilities made against them on behalf of my child, regardless of cause of such claims, actions, or liabilities or any concurrent or contributing fault or negligence of them as such may result from my child’s participation in the field trips or activities, I also agree to indemnify and hold harmless the CLOI members and volunteers, and assigns form and against any and all suits actions, losses, damages, or that which may result from my child’s participation in the trips or activities. I understand that the CLOI members and volunteers understand this release and I sign it voluntarily and with full knowledge of its significance.
__________________________________ ___________________________________
Signature of parent/legal guardian Printed name of parent/legal guardian
__________________________________ ___________________________________
Printed name of participant Date
Medical Authorization
I authorize CLOI and/or any of its authorized volunteers to call for medical care for my child or to transport my child to a medical facility or hospital if, in their opinion, medical attention is necessary. Further, I agree to pay all costs associated with the medical care and related transportation. I attest that I am eighteen (18) years of age or older or if I am younger my parent or legal guardian has signed this agreement.
__________________________________ ___________________________________
Signature of parent/legal guardian Printed name of parent/legal guardian
__________________________________ ___________________________________
Contact Number Date