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Permission Form Waiver
I ________________________________, the parent of __________________________ (“my child”), give permission
for my child to attend the ___________________________________________________________________________________.
I understand that personal injury can and may occur to my child, and I hereby authorize Name
and Title of Person Responsible Here, or another appointed youth advisor, to seek and consent
to emergency medical attention for my child as needed; and I further agree to be liable for and to
pay all costs incurred in connection with such medical attention.
I hereby release Name of Organization, its employees, agents and volunteers, from any and all
liability, claims, demands, causes of action and possible causes of action whatsoever arising out
of or related to any loss, damage or injury (including death) that may be sustained by my child
while participating in or traveling to and from this event.
The following is all of the insurance information, restric