Program Permission Form Student Name* First Last Parent/Guardian Name* First Last Parent/Guardian Email* I give permission for my child to participate in the after-school programs or clubs at Hendricks CareerTek 625 3rd Street, Suite 200, I understand that staff and volunteers will do everything possible to prevent any accidents over which they have control. However, I fully understand that participation in the program activities may involve some inherent risks to students regardless of all feasible safety measures that may be taken. As a voluntary participant in the program, I agree to accept responsibility for any loss, damage, or injury to my child that occurs during my child’s participation that is not the result of fraud, willful injury to a person or property, or the willful or negligent violation of a law by an employee or agent of Hendricks CareerTek. I further authorize staff to obtain emergency care for my child when it is deemed reasonably necessary for my child’s health or safety. I understand that Hendricks CareerTek does not provide medical insurance nor assume any liability for injuries incurred traveling to, from and during the activity. By execution of this agreement, the participant assumes full risk and responsibility for any injuries or damages, which may occur to the participant. Lastly, I understand that if my child’s arrangements change it is my responsibility to notify the Hendricks CareerTek staff immediately.* WaiverI give permission for my child to participate in the after-school programs or clubs at Hendricks CareerTek 625 3rd Street, Suite 200, I understand that staff and volunteers will do everything possible to prevent any accidents over which they have control. However, I fully understand that participation in the program activities may involve some inherent risks to students regardless of all feasible safety measures that may be taken. As a voluntary participant in the program, I agree to accept responsibility for any loss, damage, or injury to my child that occurs during my child’s participation that is not the result of fraud, willful injury to a person or property, or the willful or negligent violation of a law by an employee or agent of Hendricks CareerTek. I further authorize staff to obtain emergency care for my child when it is deemed reasonably necessary for my child’s health or safety. I understand that Hendricks CareerTek does not provide medical insurance nor assume any liability for injuries incurred traveling to, from and during the activity. By execution of this agreement, the participant assumes full risk and responsibility for any injuries or damages, which may occur to the participant. Lastly, I understand that if my child’s arrangements change it is my responsibility to notify the Hendricks CareerTek staff immediately.I understand that my child might leave the Academy site and I grant permission for my child to travel with the Academy group. Certain Academies may have a walking tour scheduled. The group will be supervised at all times by HCT staff.* Permission to participateI understand that my child might leave the Academy site and I grant permission for my child to travel with the Academy group. Certain Academies may have a walking tour scheduled. The group will be supervised at all times by HCT staff.Photo Release*I grant permission to photograph my student for promotional and/or educational purposes YES NO Please indicate if your child has any medical condition/concerns/food allergy that Hendricks CareerTek staff should be aware of:Parent Signature*Parent's Name*Enter Today's Date* MM slash DD slash YYYY Student Signature if 18 and overStudent's Name*Enter Today's Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
