MEDICAL RELEASE, LIABILITY and PHOTO/VIDEO RELEASE FORM

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MEDICAL RELEASE, LIABILITY and PHOTO/VIDEO RELEASE FORM

ALL HSE MEMBERS ARE REQUIRED TO FILL OUT THIS MEDICAL AND LIABILITY RELEASE FORM EACH YEAR.

Please note, HSE leadership will contact the parent or emergency contact immediately upon any medical incident.


PLEASE LIST THE CONDITION/ALLERGY OR N/A FOR EACH STUDENTS REGISTERED.

I hereby give permission for medical attention and treatment necessary to sustain life to be administered to my child/children who are enrolled with Homeschool, etc. in the event of accident, injury, or sickness, under the direction of the person(s) listed below (their doctor, or any emergency medical care professional), until such time as I may be contacted. I also assume the responsibility for the payment of any such treatment. This release is effective for the period of one year from the date given below."

In addition, I release HSE from any claims or responsibilities for injuries suffered during this program.

Please indicate if you authorize HSE to use any photo’s or video’s of yourself and/or your students taken during HSE Friday morning classes or any HSE sponsored event.

YOUR TYPED NAME AT THE END OF THIS FORM SERVES AS YOUR SIGNATURE.


THANK YOU!
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