Dear Parent/Guardian,
The law requires that parental permission be obtained for medical procedures on minors (under 18 years of age). The following consent form should be signed by a parent and/or legal guardian so that such procedures can be promptly carried out. We will make a genuine attempt to notify you in case of a serious emergency.
I, the undersigned parent/guardian of
______________________________________,
hereby give permission to the physicians and attendant staff to perform such diagnostic, therapeutic, and operative procedures for him/her as they deem necessary, and refer him/her to another physician when deemed appropriate.
LIABILITY RELEASE: I hereby release, hold harmless and indemnify the Montana Envirothon and all their officers, agents, employees and volunteers from any legal liability, claims, damages and costs for any injury caused by or resulting from participation in the Montana Envirothon.
I hereby grant the right to photograph my dependent and use the photo and/or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication purposes, whether electronic, print, digital or electronic publishing via the Internet to the Montana Envirothon and to its employees, agents, assigns, and a sponsors.
Signature of Parent/Guardian__________________________ Date___________
(* Signature gives consent for full participation, travel and photo consent.)
Name of Parent/Guardian:____________________________________________
(please print or type name)
Address:__________________________________________________________
Work Tel::( )___________________ Home Tel:( )___________________
Relationship to student:_______________________________________________
(parent, foster parent, etc.)
Name of Advisor accompanying student:__________________________________