Emergency Contact Information
Informed Consent and Authorization Information
During camp, we take photographs, video, and audio recordings of camp activities. Some photographs, video recordings, and audio recordings may capture your child's participation, directly or indirectly.
We may use these photos and recordings to educate the public about LEAD Agency's work, in reports to funders of the summer camp, and to advertise future summer camps. Photos and recordings may be published through our website, social media, ads, grant reports, and newsletters.
We seek for your consent in allowing us to publish photos and recordings which may involve your child as described above.
By signing this document, I give my permission for my young person(s) to be transported to and from the stated activities sponsored by L.E.A.D. Agency, Inc.
I understand that my young person(s) will be transported to different locations on field trips as part of this summer camp.
I consent for them to travel in the transportation provided and participate in the activites at the stated event.
I do not hold Local Environmental Action Demanded liable for any injury or loss/damage of property.
Informed Consent and Acknowledgement*
By signing this document, I hereby give my approval for my child’s participation in any and all activities prepared by L.E.A.D. Agency, Inc. during the selected camp.
In exchange for the acceptance of said child’s candidacy by L.E.A.D. Agency, Inc., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless L.E.A.D. Agency, Inc. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.
In case of injury to said child, I hereby waive all claims against L.E.A.D. Agency, Inc. including all staff, volunteers, and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
There is a risk of being injured that is inherent in all outdoor activities. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization*
As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named student.
In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.
Permission is also granted to L.E.A.D. Agency, Inc. and its affiliates including Directors, Staff, and Volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility.
Release authorized on the dates and/or duration of the registered camp. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child(ren), in my absence.
Consent to Electronic Signature*
BY ACKNOWLEDGING AND SUBMITTING THE FORM BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
