Release Form For Children'S Programs printable pdf download

Release Form For Children'S Programs

Release Form for

Children’s Programs

Photo / Interview Release for Children

I hereby grant permission to the Nature Discovery Center to photograph and/or interview my child,

________________________________. It is my understanding that any photographs or interviews

Child’s Name

taken, or portions thereof, will be used for public view.

I agree to participate in this project without financial remuneration, and I understand that this releases

the Nature Discovery Center, and the photographer and/or interviewer from any future claims as

well as from any liability arising from the use of said photograph/interview.

Child’s Name

Street Address

City, State, and Zip Code

Parent/Guardian’s Signature

Date

Parent/Guardian’s Printed Name

Authorization for Medical Services

I, parent/guardian of _________________________________________________, hereby designate the

Child’s Name

program leader and his/her designee to act in my behalf to authorize such hospitalization, medical atten-

tion, and/or surgery as may be required in an emergency because of illness or injuries sustained by my

child/ward while participating in Nature Discovery Center activities. I hearby assume all financial responsi-

bility for hospitalization, medical attention, transportation, and surgery provided. I request that I be con-

tacted within a reasonable time in the event of illness or injury requiring medical services.

In case of emergency, contact me at:

Home Phone: ____________________

Cell Phone:

____________________

Work Phone: ____________________

Parent/Guardian’s Signature

Date

Parent/Guardian’s Printed Name

7112 NEWCASTLE ST

BELLAIRE, TX 77401 713.667.6550

Release Form For Children'S Programs