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 LIST THE CONDITION/ALLERGY OR N/A FOR EACH STUDENTS REGISTERED.
I hereby give permission for any and all medical attention to be administered to my child/ children who are enrolled with Homeschool, etc. in the event of accident, injury, sickness, etc., under the direction of the person(s) listed below, 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 in 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.